Until 34 years old I felt 26. Then, all at once, I didn’t. The feeling, more akin to panic than a simple realization, came unannounced. I saw lines on my forehead that hadn't been there before, and felt frightened equally by their insidiousness and by how badly I wanted to erase them, each one a foreshadowing of everything that would become softer, saggier, lesser. The inevitable progression from looking youthful, to looking good for one’s age, to invisible.

Growing up, I remember strangers complimenting my mother, saying she looked 20 years younger, or that the two of us walking down the street together could have been sisters. I’d also eavesdrop on conversations between grown women talking about so and so whose husband had left her for a younger woman. Sometimes it was the woman’s fault, they said, for not taking care of herself or the marriage; most times it was simply what men did. Back then we didn’t know about preventative facelifts at 30, but the message was the same: preserve your youth to preserve your value.

If vanity can be stoked in myriad ways, there is no cosmetic procedure for walking out of a doctor's office at 35 newly classified as "advanced maternal age." Even if I could prevent my wrinkles from getting deeper, at least for a time, I couldn’t undo that label. Or the pregnancy losses, or the struggle to conceive. And since botox is off the table while I’m trying — a fact nobody lingers on when they’re busy telling you how common all of this is — the lines are only getting deeper, my body running its own agenda on both fronts simultaneously.

Alongside the pain, the losses came with a level of guilt I hadn’t anticipated — shame at a body I had thought was simply mine, now revealed as capable of failing me in ways I hadn't expected. What did it matter that I had felt 26 inside when half of my eggs were already bad? I was angry at how differently my husband and I had each lived through this. The desire itself seems so much less complicated for him — less ambivalence, fewer questions about how having a child would shift his identity. To him, the difficulty was simply nature being nature — flawed, prone to error, not something to be ashamed of. He has experienced loss and grief too, but the shame is mine alone.

Men struggle with aging too — there are midlife crises and, more recently, facelifts and looksmaxxing and peptides and compulsive longevity chasing. But the fact that a 45-year-old man can, and often does, choose a 25-year-old woman to procreate with while the opposite is never true says more about the different ways we experience aging than any hypocritical attempt to convince us we are equal in our fear of it. Grey hair and wrinkles and softer bodies are not perceived with the same apprehension in men as they are in women, and even if they were, nature has made sure we lose our viability much sooner.

We live longer, we have children later. Age is just a number, we are told, ad nauseam. And yet age still defines the most consequential things a body can do. Even without the reproductive stakes, the body finds its own ways to mark time — each grey hair, each new line arriving as evidence of a clock you cannot slow, a magnifying glass held to whatever fear lives underneath. The fear of becoming undesirable, or unlovable, or more painfully, unrecognizable: the image in the mirror at odds with the one in my mind, not even the 26-year-old I’d stayed inside, but something younger, already falsified by longing.

The deceit runs deeper than the body. I know this because I keep returning to a photo of me at twenty, living in London. There is a leather bag in the photo that I hated — a gift I carried because I had nothing else. I knew my picture was being taken, and yet there is something in my expression, something not yet closed off, not yet monitoring itself, that I cannot replicate now. Looking at it, my heart crumples in a way that looking at a photo of myself now simply doesn’t. Me then — a still from a film I am directing from memory. Me now — just a photograph. I wasn’t happier then, I wasn’t feeling more at home in my own body, I wasn’t less depressed or sad. But I was always the youngest in any room, currency I had no idea what to do with, and that, in retrospect, wasn’t only about vanity or the smooth skin on my forehead. I look at that version of me, see her running around London in her ill-fitting clothes, heartbroken and broke, and remember the feeling — the delight of not knowing, of experiencing life as a string of surprises.

Nostalgia is a trap — the same one that makes us remember the dead as better than they were. I don’t romanticize my youth, I haven’t forgotten the hardships, and I don’t believe that struggling is virtuous, but I do long for that feeling. It wasn’t just freedom, although that was part of it. What it felt like was my whole life still undetermined, the sense that I could still become anyone, that I could change my mind about anything as many times as I wanted. The tally of mistakes hadn’t yet accumulated; I felt unencumbered by responsibilities or the weight of my poor decisions.

My husband tells me this feeling was always an illusion — that we are never on any path but the one we were already on, that the other lives were never really available. He is right. And it doesn’t change or deny the feeling of abundance and discovery I had in those years. The open future might have been a mirage, but it was fuel I didn’t know I was running on, and knowing now that it wasn’t real doesn’t return it. At almost 36, I feel less at odds with myself and the world. I feel safer, more at ease, more focused on the things that matter now. I have more of everything. Except time. And that feeling. I know what’s coming, and where that should make me feel peaceful, it also makes me sad — a path already laid out, decisions already made, simply forging ahead toward what I can see coming.

Youth is not just beauty or freedom — it is the feeling of being in front of your life rather than inside it, and once you are inside it, you cannot get back to the front. If I’m still the girl in the photo, I only exist as a memory, a set of questions to grapple with now: did I do everything I thought I was going to do? Have I lived enough, taken enough risks? Do I have anything to say that makes the distance between then and now worth something?

The consolations are not hard to find. Other women’s words, other frameworks, other ways of making the loss mean something. In 1972, Susan Sontag offered this one:

Women have another option. They can aspire to be wise, not merely nice; to be competent, not merely helpful; to be strong, not merely graceful; to be ambitious for themselves, not merely for themselves in relation to men and children. They can let themselves age naturally and without embarrassment, actively protesting and disobeying the conventions that stem from this society’s double standard about aging. Instead of being girls, girls as long as possible, who then age humiliatingly into middle-aged women and then obscenely into old women, they can become women much earlier-and remain active adults, enjoying the long, erotic career of which women are capable, far longer. Women should allow their faces to show the lives they have lived. Women should tell the truth.

What truth, exactly? Because the truth is, one is not more precious than the other — wisdom over youth, confidence over wrinkle-free skin, safety over freedom. These are presented as exchanges, as if you get one thing in return for losing another, but the accounting never balances. The feeling of being at the beginning cannot be replaced. I have to live with the certainty that I have not done enough, have squandered what once felt infinite. It is greedy and immature, wanting that lightness instead of welcoming what’s coming, the dull rhythm of grown-up life. I will have children despite my advanced maternal age, I will change diapers, not sleep, forget how to write or even have interesting ideas, and my children will grow up, and I will probably not get a facelift, and maybe — just maybe — a kind stranger will comment that my daughter and I look like sisters.

The longing doesn’t ask permission.

I recently had a dream that I was hunting for an apartment in a neighborhood in New York I once lived in. I found a place that was in fact an office space, small, cramped, with no bedroom. Instead, a bed lay on top of the rooftop. I climbed in and looked at the city around me and realized I couldn’t stay — I was too terrified to sleep there, to accidentally roll over and plummet to my death.

A memory: finishing a book and asking my mother what I should read next, her walking me to our overflowing bookshelves and choosing my next one. Or me saying “I’m bored” on a lousy summer day and her reply: “pick up a book.” Or her placing a stack of new books on the low table by the sofa and me wanting to copy her — not only in the excitement of possessing them, their smell still fresh and unbroken, but in the anticipatory pleasure of having something to look forward to. Or getting the flu in fifth grade and being allowed to stay home for an entire week, bedridden not so much from illness as from the Lord of the Rings, which I had been given as a gift and refused to put down, my mother asking whether I was truly reading each page or skipping through.

I was read to from infancy, by either my mother or my grandmother. The Brothers Grimm fairytales, a book so large and dog-eared I had learned it by heart. Like all children’s stories, everything concluded with some moral wisdom to help you become a good person. But what I really cared about was the magic — the seven sisters turned into swans who could no longer speak, the magic cabbage that could guide you home no matter how far you’d wandered. Yes, the characters had to be brave, had to own up to their mistakes and eventually become the good people all stories require, but the world they inhabited was so rich and mysterious that it made all the effort toward goodness feel exhilarating.

The first novel I read on my own, at seven years old, was Heidi, by Johanna Spyri. Almost thirty years later, I can still smell the cheese Heidi shared with her grandfather in the Swiss mountains, see the meadows she ran through with Peter, and relive both the heartbreak of her separation from her grandfather and the thrill of her life with wealthy, wheelchair-bound Clara in an opulent villa in Frankfurt. While living with Clara, Heidi develops such a severe case of homesickness that she begins sleepwalking. For all my earnest attempts, I could not make myself sleepwalk, nor could I locate any wealthy relatives to be sent away to — but Heidi became a different kind of portal, one that led me to discover a reality far more exciting than my own: the one inside books.

If Heidi planted images that lodged themselves in me before I had the vocabulary to explain why, my world was turned upside down at ten when I unwrapped the first Harry Potter volume from under the Christmas tree. The memory of reading it unfolds on two simultaneous tracks — the magnificence of the story, unlike anything I’d encountered, a magical world existing not in some faraway land but inside our own, and then the actual experience of reading it, an awe and joy so total I have never been able to replace it. By the time the last book was published I was old enough to know that Hogwarts didn’t exist. But part of me has never quite accepted this. That hope has kept me reading ever since.

There isn’t a single period of my life that hasn’t been marked by books. If as a child transcendence meant fiction becoming more real than reality, as I began choosing my own books it morphed into something different — the discovery that whatever I was feeling, someone had already written it down. The rawness of first love mapped onto Wuthering Heights and Atonement; the suspicion that life might be meaningless finding company in Dostoevsky and Camus. And then there were the desires fiction satisfied that reality couldn’t — the hunger to see the world, met by Hemingway’s Paris, Márquez’s sensual landscapes, Fowles’s Greece, more solar and unchaste than the Aegean I finally swam in years later.

Coming of age through the classics is hardly singular, in the same way that wanting to write as a result of spending so much time among books has afflicted many other young people. But whether or not it made for a unique fate, it shaped my worldview and laid out the foundation for expanding my emotional range. It wasn’t therapy, or even my parents’ divorce, that taught me more about the complexity of relationships than Amos Oz, Julian Barnes or Rachel Cusk. I could see my mother’s entrapment in every female character Oz wrote — someone who married into a life she consciously chose but couldn’t emotionally inhabit, where nothing dramatic ever happens, only an accumulation of small, continuous mismatches that silently compound into unhappiness. That a man could render female complexity with such poignancy made the difficulty of so many relationships feel complete and true — it is not through a failure of understanding that we arrive at painful dissolution. We understand each other perfectly. There is simply nothing we can do to prevent the hurting, in spite of it.

I’ve heard people say they prefer nonfiction because it’s about real life. A friend recently mentioned a study showing that college students — including those in literature programs — arrive at university having rarely finished a book. I understand the instinct toward the factual, the verified, the directly useful. But life is not information. Its texture is made of something harder to locate — the things withheld, the contours of our relationships, the contradictions that accumulate into something irreversible. The woman who first placed a book in my hands was also someone I later found in other people’s fiction. That is real life.

What does it feel like to live without the particular interiority that literary fiction constructs? Can you even know what you don’t have?

Take Anna Karenina, a novel that illuminated more about women than was ever permitted to surface in the real world. Reading it as a teenager, I recognized something: the hunger, the non-compliance, the refusal to be what the world needed her to be. But I received it as tragedy, as the inevitable cost of being ungovernable; she was living in a corset, figuratively and literally, and there was no other ending available to her. What Ferrante gave me, years later, was the same woman without the corset, still complicated, still impossible, but alive and unresolved, the tragedy not death but survival — having to live as a woman who wouldn't simplify herself. Ferrante doesn’t stand back and observe from a distance, she’s inside, and the Neapolitan novels give you female ambivalence without the elegiac frame, messier and uglier and more embarrassing, more accurate. Elena is not magnificent. She’s petty, envious, self-deceiving, sexually complicated, a bad mother at times, a woman who can’t decide whether she wants to escape her origins or be forgiven for escaping them.

But admiring these writers as a reader and attempting to follow them as a writer are two very different relationships to the same work. Didion taught me what a sentence could do. She also made it nearly impossible to write one. The pleasure of being inside language — Nabokov’s lyricism paired with absolute linguistic control, Woolf’s fluid rhythmic prose, Knausgård’s precision through accumulation, Didion’s surgical clarity, which would eventually give me a name for what I had been chasing all along — has come at a cost. The more I read, the harder it becomes to bridge the gap between what I admire and what I am able to produce. The aperture that once seemed possible to close has widened into a chasm, and with every sentence I read I am newly aware of how mine fall short. If reading is all delight, writing is its opposite — the faint impression of it manifesting only in those rare instances when an idea feels fully formed, when I arrive at something previously inaccessible.

The trade-off is not always knowing how my ideas formed, my inner life having been so thoroughly shaped by other people’s fiction that I am left wondering what is distinctly mine. Perhaps this is just how consciousness works for everyone, and readers are simply more aware of it, since original thought is mostly fantasy. Writing a sentence and being unable to tell whether I thought it or absorbed it serves as an inconvenient but necessary check — I don’t get to take credit for arriving somewhere if the idea likely originated elsewhere. But questioning why I am drawn to it, finding how to express my version of it, that remains a satisfying effort.

The question of identity can be posed differently then, not through ideas but through the sense of being someone who reads, a self-concept so thoroughly mine now that I can’t separate it out and examine it. It’s not a skill I have. It’s the water I swim in. If it’s made me a snob, I’ll take it, because reading has given me things I can name and account for — a way of paying attention, a vocabulary for feeling, a standard to aim toward. But the thing it has given me that I value most has no clean name. Didion called it the shimmer: that ineffable image standing in for emotion, the simple detail that holds something too large to be said directly. At seven it was Heidi’s cheese. Then it was Tolstoy’s candle — the last thing Anna sees before she dies, everything he wanted to say about her life, its brightness and brevity and the way the world extinguished her, held in one image he never explains. Didion’s shoes: she doesn’t throw away her dead husband’s shoes because he’ll need them when he comes back. Auster, in The Invention of Solitude, finding a photograph of his father as a young man that doesn’t look like his father, a man so unknowable that even his own face in youth is a stranger. Fiction doesn’t tell you about human experience. It creates the conditions for you to have it. I keep reading because I keep looking for the next one — the image I haven’t found yet, in the book I haven’t opened yet, that will make my heart sink.

If you really loved ballet you wouldn’t eat chocolate.

The words came out of a 14-year-old, tall, blonde, bony girl who had just wolfed a huge chunk of chocolate without offering me any. She was the girl I was being measured against and routinely deemed inferior to by my ballet teacher. Not only did she have the feet for dancing, the proper turnout, the long limbs — according to my teacher, she looked like a real ballerina. The way her blonde hair tucked perfectly into a neat bun balanced on her perfectly thin neck. The way her leotard fit like a glove against her perfectly flat chest.

At 14, my chest had stopped being flat. My hips widened to an extent that made my teacher call my mother and ask her to come in urgently. She proclaimed my body changing with such violence a disaster. She called me fat and unfit for dancing with the same ease as simply saying my name. But I wasn’t just those things — the worst offense was that I was those things compared to the perfect girls. The ones whose long legs gave them a right to laugh at my body in the locker room. The ones allowed to love chocolate while I cycled through the cabbage soup diet and only had chocolate when my sister stole some for me, eaten hidden in a dark closet.

Ballet is a world of its own — its own vocabulary, clothes, mannerisms, ways of understanding music, ways of exploiting the body and imagination that belong only to the dancing universe. The draw is the beauty. I had fallen in love with it at four years old, after sitting through the full three acts of Swan Lake without squirming. I started taking lessons immediately after, and those afternoons learning steps for the Christmas or summer recital were some of the happiest of my life. I can still smell the synthetic floor covering of that studio, and the particular whiff of pulling a fresh pair of pink tights from their plastic packaging.

But professional ballet school, which I enrolled in a few years later — admitted for my self-expression and musicality, despite misgivings about my body — turned the magic into something else: constant comparison, competition, crumbling self-confidence. When the costumes, the music, the shapes your body produces are all beautiful, and the girls sitting at the barre next to you are also beautiful, you become painfully aware of the danger of being cast out of this magical world if you fail at being beautiful too. I existed between two extremes — trying and failing to manipulate my body into fitting in, and trying to stand out for entirely different reasons: be the one who memorized the steps fastest, the one who overcompensated with expression where she lacked technique.

I stopped dancing at 15. But the comparison never went away. Today my Instagram feed is full of pregnant women whose bodies have magically stayed small, the bump affixing itself without disrupting their beauty. Despite my better judgment, when I see those images I can’t help but compare myself, thinking it so unlikely that my pregnancy body would look anything like theirs. And then I feel guilty. Shouldn’t I be envious that they are pregnant and I am not, instead of thinking about bodies at all? What is beauty against life? It is not a question I have ever quite learned to ask first. I was taught to look at the girl next to me and measure the distance.

It has never been only about the body. In college I had a friend who was also blonde, thin, beautiful. The kind of cool girl who acts aloof, as if always lost in her own world, one I naturally didn’t belong to. She kept me at arm’s length, looked down on my romantic choices, my style, even my writing. She said I chose my words too carefully, that my writing was too pedantic, too concerned with how I would be perceived, nudging me toward embodying another ideal: the girl who is too cool to care.

Even now, I meet women who sort by different criteria. Someone only wants to be friends with ambitious women. Others, having become mothers, have deemed any other pursuit less complete than the holy combination of motherhood and career. Never mind that ambition is often a placeholder for insecurity, or that what someone calls a career is merely a job. Beauty and thinness have been replaced by ambition and doing it all — the same hierarchy, wearing different clothes. And what hasn’t changed is that women are doing most of this sorting. My ballet teachers, the girls in the locker room, the female friends. The system doesn’t need men to perpetuate itself. It lives in us, gets transmitted through us, sometimes by the people who are supposed to be on our side.

A friend once told me about a woman she’d met — someone famous, impressive, the kind of person worth knowing. They had started going to yoga together, each one taking the measure of the other. After a while, the other woman said: I think we should be friends. My friend told me this with satisfaction, as if the deliberateness of it were proof of discernment — that friendship, arrived at this way, meant something more. I smiled and said something appropriate. But I kept thinking about it afterward — the satisfaction on her face, and my own polite smile, and the small, shameful pang of never having been worth that kind of audition to her. How shallow, I thought. And also: why not me?

And I am not immune. I have my own criteria — depth, interiority, taste — qualities I believe make for a richer life, but which can curdle into snobbery without much effort. I look at women who manifest their way to a rich husband and feel contempt. I look at women who sort their friends by professional achievement and feel superior. But superior by whose measure? Mine. Which makes me no different from my ballet teachers.

Behind everyone’s need to sort and dismiss, there is likely a girl who once felt she didn’t deserve proximity — who learned, in some room or another, that belonging had to be earned. It doesn’t make the sorting less painful. But it makes it legible. We are all, in our own way, still standing in front of some mirror, waiting to be told whether we are good enough.

I am terrified of bringing a daughter into a world where comparison has become even more ubiquitous, where we exist not just as ourselves but as social avatars too. And I am terrified of passing on what has lived inside me this entire time. I don’t know how I would teach her to be more interested in self-realization than external validation, to resist sorting herself and others into categories. What I hope I can give her is something simpler: the image of another little girl who was once pulled toward ballet by something she couldn’t name. The pull itself being the thing worth protecting. I don’t know if I can give her that. But I am still trying to give it to myself.

What drew me to ballet was the beauty, but also the experience of being fully inside something — the transcendence, the creation of magic and entire worlds. That pull eventually transformed into a love for writing. And even though I still catch myself comparing my body, I have somehow managed to keep writing uncorrupted from that instinct. Because writing, even when it is paradoxically about my life, is about something outside of myself — understanding, making sense, connecting to the person who reads.

I have been lucky to find that same quality of presence elsewhere too. My mother. My sister. A handful of friends who have never once asked me what I am working on as a way of deciding how to feel about me. What they offer is harder to name and easier to feel — the gift of someone who is simply, fully there. Conversations that move without agenda from the trivial to the most intimate, where you can say the dark thing, the shameful thing, the thing you haven’t said out loud yet, and what comes back is not judgment but attention. The sense that what matters right now is not what either of you has achieved but what is actually happening between you.

It is the same thing, I believe, that writing asks of me. A life organized around interiority doesn’t feel like knowing your worth or any of the other tired reassurances. It means wanting what you actually want. Becoming so absorbed in something — dancing, writing, looking at things and asking questions — that who you are and at what scale you are achieving becomes, if not irrelevant, then secondary. It means choosing presence over measurement. Connecting over sorting. It means, often, eating chocolate out in the open.

Crossing 7th Avenue onto Bedford Street on a summer day in New York City is entering a magic realm. The tops of the trees touch each other, forming a canopy that makes everything disappear — the rush of traffic, the blazing sun. It’s like getting tunnel vision, but the type of tunnel Alice in Wonderland would crawl through. My steps carry me through without thinking. Typically I’d arrive at this crossing from Soho, having walked down Prince Street. I continue through the Village, right on Grove, slalom to Bank, with its movie-set townhouses that I can’t help but imagine myself living in. Then down to the West Side Highway — the perfect distillation of what New York energy is all about — everyone moving with a force and self-possession that announces, without a word, that they are exactly where they belong. And then Pier 26, my favorite spot in the entire city. I stop at the water every time. There’s a wall there that says I want to thank you; I’ve never been entirely sure who it’s addressed to, or whether it matters. I look at the little cluster of buildings peeking through at One World Trade and I feel, briefly, set right.

I started doing this walk during the pandemic and it became the closest thing I have to a resurrection — reliable, repeatable, mine. Through the happiest times of the last six years, as well as the worst, I’d walk this route. Sometimes alone, most times with Emi. Most times talking, sometimes in silence. But no matter how hopeless we felt at the start, we’d inevitably feel better by the end. As if the city had lifted some of the heaviness, shedding bits of it at every pit stop — along the Village blocks, at the Pier, in front of our favorite Tribeca building.

When I was younger and dreamed of living in New York — drawn to it through movies and books — I wanted my life to feel like a movie. It sounds juvenile, but looking back I can tie that longing to something honest: wanting to live in a constant state of awe. There are novels, and then there’s a Paul Auster novel. There are movies, and then there’s a PT Anderson film. There are TV shows, and then there’s Succession. There are cities, and then there’s New York. Auster, who knew the city better than almost anyone, called it the nowhere he had built around himself — nowhere being, in his telling, the highest possible compliment. A place so total it dissolves the anxious self into something larger. If you want the best of what life has to offer, where else would you go? The city is not pretty, or clean, or calm. But it’s as honest as they come. It has bite.

That awe, that proximity to greatness, held me through the hardest times, both reminder and reason to keep going. In New York I lived more intensely than I ever had. I wrote. I did my best creative work. I built a business. And I never felt lonely. Not in a city where ambition is so densely concentrated it becomes atmospheric — where you absorb other people’s drive the way you absorb secondhand smoke, whether you want to or not.

But belonging to New York didn’t happen instantly, though it happened faster than anywhere I’d ever lived. I grew up in Bucharest, a place that couldn’t contain my appetite, and spent seven good years in London before Emi’s work brought us to New York. I didn’t need convincing. London I had chosen with my head; New York I said yes to with my whole body, before my mind had finished the sentence. It was, after all, New York. Within six months I wasn’t adjusting anymore. I was simply there, in the place I should have always been — the limitlessness of it making it feel more like home than where I’d come from. Years later, Emi’s work would require another move. This time to Austin. There was nothing to convince me of — the reasons were obvious, the math was simple, and we packed our bags. If Didion got to call hers Goodbye to All That, I only got goodbye to all that I love.

There is a particular kind of self-knowledge that only becomes visible when you’re somewhere that reflects you back. New York was that mirror for me — not flattering, but accurate. I arrived as someone still in the lightness of her twenties, the entire future spread out with no end in sight, still able to postpone things, still allowed to make mistakes and change course. The city received all of that and then, at some point I can’t quite locate, began to demand more. Or perhaps I did, and the city was simply the place where the bill came due. No terms are announced, no warning given. You just wake up one day and the stakes are higher than they were, and you either rise to meet them or you leave.

I shed my youth and my naivety in New York, traded them for the pressure of real responsibilities. I let it inspire me to write and followed that thread, only to fail to get into film school. I worked jobs I didn’t like. I remember the summer of 2023, making the rounds to investors’ offices all around the city, sweating through the unforgiving July heat and having door after door slammed in my face. The city is like that too, marvelous but harsh, offering everything at your feet but never for free. Greatness doesn’t just rub off on you if you’re not cut out for the grind. The reflection showed me I was in the right place — but I’d have to keep earning it.

My sense of identity has always felt naturally intertwined with the city — treading the same streets as my favorite writers and artists, walking everywhere, absorbing the energy. The fact — not just the idea — that you can, in a single day, work, meet remarkable people, walk into your favorite bookstore, slip into the Met just to stand in front of your favorite painting, spend your evening marveling at a Balanchine piece at New York City Ballet, and walk home through Central Park somehow even more alive than when you woke up. I didn’t know then that those days would not be infinite.

Like anyone leaving behind something they loved, I tried to convince myself in the months leading up to the move that a respite from New York’s relentlessness would be welcome. I pictured Lady Bird Lake, people strolling alongside the water as if nothing were ever pressing or important; full of sunshine, ease, and mothers pushing strollers down leafy streets past houses that seem always asleep. I told myself the trade-offs would be worth it. More space. A house with a backyard. A sauna. Cooking all our meals at home. We ended up moving into an apartment in the most walkable part of the city, no backyard, no sauna, and I still prefer reading to cooking.

People talk about longing for a place you’ve left as if it were nostalgia — soft, vaguely embarrassing, the province of people who can’t move on. But what I feel isn’t the shapeless ache of someone pining for a past self. It’s more precise than that. It’s the feeling of walking around without a mirror. Of knowing exactly who you are and having nowhere to see yourself.

Austin is not a city of culture or energy or creation. It is a place built around a particular vision of the good life — and the version of me that vision requires is the domestic one, the one who has traded the Met and New York City Ballet for a nursery and a baby. I came here to step into that life. I am still waiting to. And in the meantime I have neither — not the city that made me, not the life I moved here for. I wake up surrounded by the same things I had in New York, and then I look out the window. A big flat nothing. I walk to the gym on a dirt trail with insects buzzing in my face — where others would see nature, I see countryside. I take driving lessons because I now live somewhere that requires a car, even though cars terrify me. There’s no bookstore to walk into, no mirror to reassure me that I’m still there.

Last week I stopped by the grocery store. There were no bags at the checkout. I asked the cashier for one. She handed me a cardboard box. I said, what am I supposed to do with this? She said, carry your groceries to your car. I said I didn’t come by car. She replied: well, I don’t know how you got here.

I said Uber. But in my head I thought: yes — I don’t know how I got here either.

The only things that are here are Emi, my books, my writing, and the waiting.

I’ve been told many times that raising children is easier in a place like Austin. The space, the schools, the slower pace. But I keep thinking about what New York gave me — not just the experiences, the education of walking those streets — but the bite. The particular quality of a person shaped by a city that demanded the best of them. That is what I want to pass on. I’d rather my children have bite than a backyard.

And so the walk on Bedford Street, every time I manage to get back to it, remains the closest thing I have to seeing myself clearly. The canopy closes over my head and everything disappears — the waiting, the uncertainty, the in-between. For the length of one walk, the city lifts the heaviness, the same way it always has. And for a moment I am not suspended between two lives. I am just here, moving through the place that made me, still myself.

“See how your left foot is pushing more into your right? Could be something related to your relationship with your father,” the woman said as she touched my bare feet. “I have no relationship with my father,” I answered. She just stared at me, unable to come up with a different explanation for the mysterious misalignment.

The year was 2019 and I had signed up for a yoga teacher training. I wasn’t a devoted yogi, but I liked moving my body that way, the flow of it, and I wanted to understand more about how bodies work. For someone who grew up dancing, yoga promised a similar rigor but without the violence of a Romanian ballet school in the ‘90s. The truth is, I was also bored, and at the time it seemed like the perfect distraction to throw myself into—long days of studying the body, moving it, learning.

But we didn’t really learn much about the body. We mostly listened to various teachers spew esoteric teachings and talk in a language that approximated horoscopes and birth charts. Everyone else in the training seemed completely at home while I hated every minute of it. I had hoped to figure out tendons, muscles, and shapes my body could produce. Instead, I watched someone read feet like tea leaves and could not muster the same enthusiasm as my colleagues. I witnessed a teacher encourage one of the participants to get off his OCD medication with the same nonchalance as if she were recommending the best yoga mat. She lectured about surrender, and when I put my hand up and asked for a clearer explanation, she told me I didn’t get it. That was the only time I agreed with her.

I didn’t complete the training. After a couple of months, my body refused to drag itself to the downtown studio and sit through another day of so-called yoga. That didn’t bother me—in fact, I felt immense relief the day I stopped going. But I couldn’t shake the feeling I’d had in the room: being the sore thumb that stood out, the only one who didn’t enjoy it, the only one who couldn’t get it. Everyone else had seemed happy to be there, filling entire notebooks with an amalgamation of textbook yogi parables, borrowed principles from Chinese medicine, Burning Man’s gospel of radical love, and the Instagrammable, westernized distillation of what was once a coherent Eastern philosophy.

I never went back, but the yoga studio kept appearing in my Instagram feed. In fact, it never left. Seven years later, my feed is still full of people hoping for the magic cure. Teacher trainings might not be as popular, but Chinese medicine seems to be all the rage. It’s impossible to escape the videos of people boiling huge pots of roots and herbs, proclaiming bone broth the “new botox,” or the Human Design experts who tell you to plug your chart into ChatGPT and create a blueprint for life that will guide every decision you make—from something as benign as whether you should drink matcha versus coffee to how to pick the most “aligned” career. Reading feet, injecting peptides, boiling herbs, or seeking absolution in the expensive rooms of Lanserhof—they’re all different expressions of the same magical thinking. The promise of a system that will grant us control over the uncontrollable.

I think of Thomas Mann’s The Magic Mountain, where wealthy Europeans travel to a Swiss sanatorium to cure their tuberculosis and end up staying for years, convinced that the mountain air and the routines of the clinic are the only things keeping them alive. They become so absorbed in the world of the sanatorium—its hierarchies, its schedules, its promises—that they can’t imagine leaving. The outside world becomes unreal. Only here, in this specialized environment with its specialized knowledge, can they be truly well.

The modern wellness retreat offers the same fantasy: escape from regular life, submission to a superior protocol, transformation under the guidance of someone who knows better. But here’s what Mann understood that the Instagram posts never acknowledge: the magic only works on the mountain. The moment you leave, everything collapses. The protocols can’t be maintained. The purity can’t be preserved. Real life—with its compromises and chaos and the inability to control every input—reasserts itself.

The promise is always that you CAN take it with you, that the transformation is permanent, that you’ll return to your life fundamentally changed. But what actually happens is you return to your life, and your life is still your life.

So why do we keep going back? Not literally back to the same retreat or training or protocol, but back to the pattern—the belief that the next system will be different, will finally stick, will be the one that actually transforms us.

There’s something distinctly American about this hunger for the next cure. Not the retreats themselves—Europeans invented the sanatorium, after all—but the way we approach them. The fervor. The speed with which we adopt and discard. The ease with which we strip practices from their cultural contexts and repackage them as solutions.

In France, people eat butter and drink wine and seem unburdened by the anxiety that they should be doing something else, something better, something more optimized. In the Nordic countries, people swim in cold water and sit in saunas because that’s what people have always done, not because they read a study about cold plunges and mitochondrial health. These aren’t wellness protocols—they’re embedded in culture, in tradition, in a way of life that doesn’t require constant interrogation or improvement.

Americans, by contrast, are always looking elsewhere for answers. We borrow the surface of other traditions—yoga without Hinduism, Chinese medicine without Chinese philosophy, ice baths without Nordic stoicism—and convince ourselves we’ve found the secret. This can be a kind of innovation, an openness to new ideas. But it’s also deeply superficial, a collection of techniques severed from the cultures that created them, the very rootedness that gave them meaning.

This creates a specific vulnerability. When you have no received wisdom about how to live, no traditions passed down through generations, you become hungry for any system that promises answers. You become, in other words, the perfect target for a guru. When you’re unmoored, even a bad map feels better than no map at all.

The desire to commune and belong is universal. But what separates a community from a cult? Perhaps it’s the degree of fervor, the rigidity of dogma, the presence of a guru figure. Or perhaps it’s the paradoxical isolation that emerges when these microcosms become severed from tradition and reduced to technique—not a way of life but a hack. Yet we submit to these practices—the teacher trainings, the retreats, the longevity communities—trading agency for the illusion of control.

In Nine Perfect Strangers, a group of people arrive at a wellness resort seeking transformation and instead find themselves trapped in someone else’s vision of salvation. The resort promises healing, but what it really offers is control—an omnipotent guru, a system that claims to have the answers. The guests surrender themselves to it because the alternative—accepting that some things cannot be fixed, that suffering is part of life, that we will all eventually die—is unbearable.

The language of wellness borrows heavily from the language of purity and cleansing, concepts with deep religious roots. Detoxes, cleanses, elimination diets—these aren’t just about health but about purification, about ridding the body of contamination and sin. There’s an almost Puritanical quality to the way we approach our bodies now, a belief that if we can just be clean enough, disciplined enough, we might transcend our mortality.

Purity, transcendence, obsession with youth are hardly new concepts. Hollywood built an empire on the promise that beauty could be preserved, that time could be cheated with the right combination of discipline and intervention. These are all expressions of the same desire for control, for cheating nature. What feels different now is the democratization of the fantasy—myriad longevity and optimization tools available to anyone willing to believe that uncertainty can be solved.

I understand this impulse. The yoga room didn’t convince me, but the hunger it represented followed me for years. I tried eating paleo and keto, fasted, took supplements whose names I can barely pronounce. I tried psychedelics.

I remember lying on the floor of our Soho apartment, the noises from the street becoming more and more muffled. As the psilocybin took hold, my mind filled with the kaleidoscopic images everyone talks about. I felt that famous oneness, that dissolution of boundaries between self and world. And underneath it, maybe because of it, I could feel all my pain and sadness more acutely than ever. The drug hadn’t removed anything. It had just made me more aware of what was already there—that I will always be afraid, feel alone, crave certainty and answers. I looked at my husband, in pain too, and saw that I couldn’t help him either. I could love him, hold him, but not fix him. Each of us simply had to live alongside what is hollow, flawed, and unclean.

The truth I learned on that apartment floor hasn’t made me immune to the promise. If anything, it’s made me more aware of why the promise works. We want desperately to believe that somewhere, someone has figured out the formula—that if we just find the right system, we can transcend the fundamental uncertainty of being alive.

We can’t. But we keep looking anyway.

When people are asked whether they want children, most will respond “yes,” “no,” or “I don’t know.” My answer is yet another question: how do I know the question is sincere?

I make sense of everything that happens to me, or around me, by questioning, internalizing, intellectualizing. It has made my therapist’s job easier, but it has also prevented me from feeling some of the things that cannot be fully lived through intellect alone. I can think myself into a deep hole of not doing, not moving forward. When every thought or idea is deconstructed to its smallest particle, it sometimes has the opposite effect of arriving at a core. It arrives at nothing.

I was a curious child who turned into an inquisitive adult. I like digging for answers, which is likely why I prefer to spend my time reading and writing more than anything else. But lately, this way of existing in the world has failed to achieve its main purpose: making me feel in control.

The questioning is armor. If I don’t know whether the question is sincere, it leaves open the possibility of maybe not fully wanting something and therefore not suffering so much if I don’t get to have it. Being certain of one’s desires and wants implies a level of risk-taking, of grabbing hold of a slice of the world and claiming it as your own. Paradoxically, I am a decisive person. I can easily point to things I don’t like or don’t want. But when the stakes are high—a child, creating something and putting it into the world—evasiveness seems easier.

After my miscarriages—two of them—this protection mechanism went into overdrive. I found myself thinking, Maybe I don’t even want this. I was pre-grieving, pre-disappointing myself, building a moat around the vulnerability of wanting. The body remembers loss even when the mind tries to outthink it. Losing two pregnancies, going through endless medical investigations that yielded no answers or resolutions, created a pain I had no idea how to simply feel. So I did what I always do: I questioned whether I wanted it in the first place.

But here’s what the questioning couldn’t do: make the grief feel theoretical. The body had already answered. I spent a good part of Christmas Day, mere weeks after my second miscarriage, sobbing—the kind of crying small children perform: uncontrollable, feral, ugly. You don’t grieve that intensely for something you don’t want. I’ve had trouble sleeping since, my anxiety so palpable I can feel it as if there’s another presence in the room I could touch. The questioning was trying to protect me from a wanting that had already announced itself through loss. But I don’t know how to go beyond that—how to “feel” my feelings, or, in pop therapy’s favorite word, “process” them. I resort to questioning.

What if having a child will squander whatever shred of unfulfilled potential I have left? What if it reveals that I’m a horrible mother—selfish, afraid, hollow?

The real fear is more specific than that. Right now, despite my lack of discipline, I still have desire. I wake up wanting to write. I have ideas that feel urgent, a creative impulse that won’t leave me alone. What if motherhood erases that? Not just because I’ll be exhausted—though there’s that too—but because the sharpness will dull. Because the part of my mind that reaches for language, that notices things, that needs to make sense of the world through writing, will quiet. Or worse: what if it stays alive enough to taunt me, but I can no longer justify spending time on it? What if motherhood provides such a complete, socially sanctioned answer to the question of how to spend my days that writing starts to feel beside the point?

And then there’s the other fear, the one that makes me most ashamed: what if I let it? What if I use motherhood as the final, noble reason I never had to find out what I’m capable of? This isn’t like the projects I’ve started and stopped, or the ideas I’ve let trail off. This is choosing something that could give me a lifetime’s worth of excuses for never finishing anything again. The most socially acceptable form of giving up. Who could argue with a mother who says she doesn’t have time to write?

There’s tension, too, in wanting to model something for my child—someone who makes things, who finishes things—while being perfectly aware that having that child might be what prevents me from becoming that person.

I keep looking for permission in other women’s words—writers who’ve grappled with this same fear. Sheila Heti spent years interrogating her own desire for children, writing: “Whether I want kids is a secret I keep from myself—it is the greatest secret I keep from myself.” Her narrator in Motherhood uses coin tosses and tarot cards to answer the question, as if outsourcing the decision might make it less terrifying. What struck me wasn’t her eventual answer but her admission that the questioning itself was the point—a way to avoid the vulnerability of sincere wanting.

In Alba de Céspedes’s Forbidden Notebook, Valeria Cossati buys a notebook on a Sunday in postwar Rome—an illegal purchase from a tobacconist—and begins writing in secret. She hides it in a sack of rags, an old trunk, an empty biscuit tin, always at risk of discovery by her family, who would laugh at the idea that her life is interesting enough to write about. To be a good mother and wife, she must pretend she wants nothing else.

Elena Ferrante’s Lenu, brilliant and striving, fears that motherhood will dilute her work, make her ordinary—that the intellectual life she fought so hard for will be reduced to the mundane. And in The Lost Daughter, the narrator Leda describes herself as an “unnatural mother,” someone who briefly abandoned her children to pursue her own work, and who carries the guilt and relief of that choice in equal measure.

Leslie Jamison, writing in Splinters, describes the opposite impulse. Where I stay frozen in questioning, she forced herself into certainty: “I wanted my whole self to want something, no questions asked.” She made promises before figuring out if they were promises she wanted to make. But that false certainty, she writes, is what she’ll have to keep answering for. Maybe there’s no safe version of wanting—not the over-questioning, not the forced certainty. Just the vulnerability of letting yourself want what you want.

These women refuse to resolve the ambivalence. They don’t offer certainty or clear paths forward. What they show me is that the questioning itself—whether it’s Heti’s coin tosses, Valeria’s hidden notebook, or Jamison’s forced certainty—is always a response to fear. Fear of wanting something you might not get. Fear of losing yourself. Fear that the choice will reveal something unbearable about who you are or what you’re capable of.

They also show me that the questioning has to end somewhere. Not in certainty, but in acknowledgment. In letting the desire exist without the intellectualization or pre-disclaimers. In committing to the compromised, complicated version instead of waiting for the pure feeling that will never come.

I want a child. I don’t know if I can trust this wanting, but I don’t think I can trust my questioning either. So I pay attention instead. To the cold winter walk when I saw a baby bundled in a stroller, plump cheeks flushed, and felt something catch in my throat—the thump in my belly that was just wanting, wanting to be the one pushing that stroller. Or when I put music on and dance around the house, my head filled with memories of dancing with my mom when I was little, and feel—so instantly, without warning—an anticipatory joy at the thought of doing the same with my own child.

These moments don’t require certainty. They just are. And maybe that’s enough to begin with.

Seventeen years ago today, I climbed into a car not knowing I would never get off that ride. Emi pulled over in his white Mazda, I got in, put out my hand and said “I’m Sabina, nice to meet you,” and off we drove into a future neither of us could have predicted. Did I know, in that instant, that we’d still be together all these years later, that we’d build the life we have now? I didn’t have a clue. I just knew I had met someone who shared my curiosity, my sense of wonder, my hunger for more than what we’d been handed. We didn’t have much in common—different upbringings, different interests—but I felt like I’d met my match.

A few months into our relationship, that intuition materialized. We were driving around in the white Mazda when Emi said he had something important to tell me but didn’t know how. He had decided to move to London because he didn’t think he could build the company he wanted in Romania. I said, “No fucking way—I’m moving to London. I got into university and didn’t know how to tell you.” I don’t believe in fate, but I believe in luck, and meeting so young was the luckiest hand we’d been dealt.

Since then, we’ve lived in four cities, across three countries and two continents. Emi has built multiple companies. We’ve been through moves, career pivots, losses that tested everything. At some point along the way, the naive intuition became earned knowledge. When people ask what makes it work, I don’t have a formula. But love isn’t what sustains a relationship—love is the result of what sustains it. Compatibility, the willingness to show up when things get ugly, and enough respect that you still like each other on the other side.

Compatibility, the way I see it, has nothing to do with passion or even shared interests—although it’s easier to build shared interests when you’re growing up together, molding and being molded by one another. What matters is that we’re equals in the ways that actually count. Not identical—our strengths are completely different, our intelligence is of a different type—but intellectually, emotionally, we speak the same language. We also matched in our mess, which turned out to be just as important. Neither of us came with addiction or rigid belief systems or the kind of baggage that requires a savior. Everyone is fucked up. The trick is landing in roughly the same weight class.

Equals, but not the same. It took me years to understand the difference. I admire Emi—I’m always in awe of what he’s capable of—but I’ve never worshiped him, never thought “How lucky I am that he chose me.” More like: “How lucky we are to have found each other.” When I was younger and less self-assured, I would look at his success, his confidence, and think that becoming more like him was the answer to feeling better about myself. This wasn’t about competition—which I find one of the most destructive forces in a relationship. It was about looking at someone I cared for and trusted and thinking that by emulating his path I would find my own. As I grew more into myself and into our relationship, I paradoxically returned to who I was when we first met.

Growing into yourself doesn’t just happen by getting older. It happens in the hardest moments, when everything you’ve built feels like it might disappear. A few years ago, we went through the hardest period we’ve had together—not because of our relationship, but because we faced a loss that threatened everything we’d built. The kind of crisis where you either turn on each other or toward each other. I remember seeing Emi at his lowest, and my first thought wasn’t panic—it was clarity. This is who we are when things fall apart. Some people become monsters under pressure. Some relationships crack because pain gets confused with blame, and what you once loved about someone becomes unbearable. We turned toward each other. I kept admiring him—respected him more, even, for not collapsing. And I learned something about myself too: I could hold things together when everything felt like it was breaking.

Crises are useful tests for relationships, but they don’t sustain them. What sustains them are the small things, repeated over years, that allow you to arrive at a point where it feels like it all “just works.” We don’t try to change each other. Emi is not going to be more patient. I’m not going to stop being judgmental or cynical. We know this about each other and we’ve stopped pretending otherwise. Trying to re-engineer a partner is just condescension in romantic packaging. It says you’re not quite enough, but I can fix that.

That doesn’t mean we don’t challenge each other—or never push back. Respect means seeing someone clearly, flaws included, and choosing them anyway. We also don’t keep score. I’ve seen it in other couples, that subtle impulse to tally who did what, who owes whom. I did X so you owe Y isn’t love—it’s accounting. It makes generosity feel like debt. When you’re with the right person, someone who isn’t interested in winning at your expense, generosity doesn’t feel like giving something up. You notice what you’re good at, take it on without fanfare, and trust the other person to do the same.

We live in a world where movies like Materialists get made—where the moral is choose chaos as long as it’s passionate, pick the broke artist over stability, ignore compatibility because love will figure it out. I don’t buy it. Passion is easy. But kindness—the unglamorous sort that shows up when you let something go instead of being right—is far harder. When you make the reservation every Friday for seventeen years. When you see someone at their worst and don’t resent them for it. Kindness gets sacrificed at the altar of being “heard” or “validated,” as if those things build anything that lasts.

Here’s the part people don’t usually say: even with all of this—the partnership, the respect, the family we’ve built together—I still feel empty sometimes. Frustrated that I haven’t achieved what I wanted in other areas of my life. And that’s not a reflection on the relationship. It’s not that it isn’t “enough.” There’s no such thing as enough when you’re a living human, needy, egotistical, flawed. Our relationship is the greatest accomplishment of my life. It’s the main source of joy and meaning for me, and yet, I can still feel lost about my own path.

And sometimes—not often, but sometimes—I feel completely alone. Not because of anything Emi does or doesn’t do. Just alone in the fundamental way we’re all alone. No matter how well someone knows you, how deeply they love you, there’s still this part of you that stands apart. An island of your own thoughts, your own pain, your own way of seeing the world that can’t be fully shared. This scares me in the same way death does—we all die alone. It’s singular, solitary. Even the best relationship can’t erase that essential separateness. That’s the condition, not the flaw.

Seventeen years in, here’s what I know: love doesn’t solve ambition, flatten pain or erase existential loneliness. But it’s the thing that makes life worth living. The daily building of something that didn’t exist before. Two people turning time into a shared history, harvesting luck, paying attention. The accumulated weight of years spent choosing each other, again and again.

If I could teach a masterclass on taste versus discipline, I'd make more money than I ever have—which is not much, because I have plenty of the former and little of the latter.

There wasn’t a specific person or moment that cemented my belief in my good taste—that was all me. I wanted to be someone with good taste: well-read, well-spoken, the kind of person who can sit through eight hours of Angels in America and actually enjoy it, who wears The Row and can tell a Sargent painting from a Cassatt. I’ve built much of my identity on refined taste, in part because I genuinely appreciate beautiful things, but also to hide what I’m ashamed of: my habit of starting things and not finishing them.

In The Worst Person in the World—a favorite of mine—Julie is asked what she does. She hesitates, then lists all the things she’s tried: medicine, photography, writing. Each one abandoned before it could define her. The film captures something I recognize too well—the fear that choosing one path means closing off all the others, that committing fully to something ordinary means accepting you’ll never be extraordinary. So you keep the options open. You keep starting over. And you end up, at 30-something, with nothing finished.

Some people are problem solvers. They thrive when running toward challenges rather than away from them. Everybody wants those people on their teams, building things, fixing things. No one has explicitly told me they wouldn’t want me on their team, but I wouldn’t hire me. I’d want to run the team—the line between taste and vision is blurry enough that I could justify it—but I wouldn’t count on myself to solve the hard shit. Stamina and temperament are just polite masks for the real culprit: ego.

When you have good taste, you also have high standards. You can’t suffer mediocrity (despite having lived with my own for 35 years), and you equate making with making something great. Some people write for the pleasure of writing. I write because I hope I’ll be Joan fucking Didion. The irony? This desire has prevented me from writing as much as I should have if I wanted to be even 25% as good as Joan Didion. Because that woman put pen to paper.

The problem with good taste is that it leads to self-indulgence and, worse, complacency. You can get away with more if you appear—and to some extent are—smarter than average. You get things quickly. You’re full of ideas, some yours, some borrowed from the greats you keep reading. You express yourself with the ease of someone whose lived experience translates naturally into captivating narrative. This isn’t how you build an impostor—those are the ones who ask ChatGPT to summarize a Paul Auster novel instead of reading it—but it is how you build a person whose compass points only toward signals from others.

“The others”—the ones who deem Joan Didion great—and the external validation that feeds this demon: these are things I haven’t been able to break with. Is it because I secretly hate myself? Too strong a sentiment for someone with at least one redeeming quality: good taste. But as I grow older, I grow more ashamed of my lack of discipline. Thinking about having a child makes me face something ugly: appearing impressive to others will never fill the void of feeling utterly unimpressive when the audience is gone.

When I applied to film school and got rejected, I felt betrayed. I’d been so certain I would get in—it would be the mecca for a person of good taste. I didn’t keep trying to make films. I told myself I would have hated school anyway (probably true) and that I couldn’t make it in the industry without the right connections (also probably true). But there’s still a folder on my computer with scripts and storyboards that, while far from Sofia Coppola masterpieces, I loved working on. One story in particular—based on growing up in ballet school—still feels like the truest thing I’ve ever written. It has never seen the light of day because I was waiting for “the others” to tell me it was great.

When I decided to shut down my company after three years of hard work—after building a real product with real customers—I told myself we didn’t have product-market fit (partly true), that investors didn’t want to give us money (true), and that I’d run out of funds to keep building (true). It was easier to give up than to sit with the pain of not knowing how to turn things around. Not knowing how to come up with a better idea, to pivot, to be the kind of person who can actually run a real business. And worst of all: the unspoken fear of “the others” saying, “Ah, that girl Sabina who started and failed at yet another thing.”

The pattern repeats because the fear underneath never changes: better to exit before the verdict comes in.

I’ve given up on things when they got hard. I haven’t started things because I was terrified of doing them and discovering I wasn’t that smart or special. That thought continues to be a black hole, ready to eat me alive. Could I live with my once-and-for-all proven mediocrity? Could I tolerate this person if I allowed her to demonstrate her full potential for failure or nothingness? I don’t have an answer. No amount of “radical” self-love or self-acceptance could make it less painful. But maybe I could dislike her a little less if she gave it her all.

One in four pregnancies end in miscarriage, and so did mine.

At my nine-week scan, a heartbeat that had been there was no longer. I wasn’t shocked — that number, one in four, was something I’d been aware of from the beginning. But knowing the statistics didn’t soften the grief. Despite understanding the science behind why miscarriages happen, I still found my mind spiraling: maybe I had gone too heavy on squats at the gym, or maybe it was that one time I accidentally used a body wash with salicylic acid, or maybe it was all those days swimming in the Mediterranean.

My very kind OB-GYN reminded me that just because those thoughts appear doesn’t make them true. There was nothing I had done — or not done — that caused my miscarriage. Nearly all miscarriages that happen in the first trimester are caused by chromosomal abnormalities — errors in an embryo’s genetic material (too many, too few, or structurally altered chromosomes) that disrupt normal development.

For someone who has spent nearly a decade optimizing her health, accepting how little control I have over pregnancy outcomes has been humbling. By all measures, I’m exceptionally healthy: I eat well, I exercise daily, my sleep is dialed, my supplement stack is clinical, and I get more preventative scans than most people I know. But this is where the wellness industry, the whole optimization complex, paints a false picture. Constantly measuring, tracking, and optimizing your health doesn’t give you control — only the illusion of it. You can be the picture of health and still get cancer. Or a brain aneurysm. Or, if you’re a woman, a miscarriage.

More optimization isn’t always the answer, in the same way more data isn’t either. I love my data — I track everything — but trying to conceive and going through pregnancy loss showed me how flawed data can be. I used the Mira monitor to track my hormones and pinpoint ovulation with obsessive accuracy. It’s a fantastic tool for identifying fertile windows or spotting hormonal imbalances. But when I looked at my baseline hormone levels, the data suggested they were too low for me to conceive. Yet, I did — less than three months later.

It also didn’t matter that I was healthy and “optimized” when I faced unexpected complications from the D&C procedure after my miscarriage. When you miscarry, it can take weeks for your body to recognize that the embryo has stopped developing. There are usually no clear signs — no bleeding, no pain — and the diagnosis comes during a routine ultrasound, when no heartbeat is found or growth has stopped. It’s called a silent miscarriage.

You’re typically given three options: wait for the body to expel the pregnancy tissue naturally (which can take weeks), take medication to trigger the process, or undergo a surgical procedure (a D&C). I chose the procedure because I wanted a quicker recovery — physically and hormonally — so we could start trying again.

Yet again, my body didn’t cooperate. The physical recovery from a D&C is usually swift, but I experienced severe pain and bleeding that lasted nearly two weeks. This is rare and likely won’t happen to you, but it did to me. The complications didn’t end there: hCG, the pregnancy hormone, is supposed to gradually decline as the tissue clears, eventually returning to zero. Mine didn’t. For over a month, it stayed elevated, keeping my body in a kind of limbo — pregnant, but not.

Once the bleeding and pain subsided, I slowly regained my energy and resumed my normal routine. Recovery timelines vary — you might feel fine in a few days, or it might take weeks. Listen to your body.

The emotional recovery, on the other hand, is an entirely different beast.

Trying to become pregnant — becoming pregnant — is at once banal and miraculous. The moment you see those two lines on a pregnancy test, it becomes your center of gravity. You change what you eat, what you put on your skin, what you think about. And no matter how rational or data-driven you are, you start to imagine the future: a baby in your arms, a new life unfolding.

Pregnancy is perhaps the greatest test for anyone with anxiety or a need for control. Each morning you wake up wondering if you’re still pregnant. You live between fear and hope — praying nothing has gone wrong, while allowing yourself to dream. When the worst happens, what hurts most is the loss of the imagined future.

I felt it all: deep sadness, frustration that we were back to square one, fear of it happening again, guilt (even knowing I did nothing wrong), and that mean voice asking if something was wrong with me — too old, too broken.

There’s nothing I can say that will make emotional recovery easier, except this: you are not alone, allow yourself to feel everything, and avoid social media like the plague.

When I became pregnant, the algorithm turned into a pregnancy oracle I never asked for — endless videos of women detailing their morning routines, what they ate, what supplements they took, how they dressed, what they bought for their nurseries. Even when the content was benign, it was relentless. More problematic, however, were the horror stories — miscarriages, stillbirths, traumatic births. These stories matter. It’s important that women speak about what has for too long been silenced. But constant exposure to pain without context can be destabilizing. The algorithm doesn’t know what you need; it only knows how to keep you engaged. It connects you to experiences that have nothing to do with your own life, sometimes fostering empathy but more often amplifying fear.

The culture of sharing has blurred the line between expression and performance. I’ve seen women post videos the day their miscarriages happened — faces swollen from crying, voices trembling. I don’t judge them; I understand the impulse to make meaning out of something unbearable. But it also makes me wonder what happens to our grief when it’s lived out online, when every feeling becomes an offering to the algorithm.

Social media leaves no room for quiet — for sitting with what has happened and letting meaning form slowly. It rewards immediacy, not reflection. You’re expected to share before you’ve even processed, to narrate your grief before you’ve had time to feel it. Everything becomes content: even loss, even pain, even the most private moments of unraveling. There’s no space to hold something sacred or unfinished — to simply exist in silence without broadcasting it.

After all that noise, all that analysis, what remains is the body.

My body has slowly recalibrated. The bleeding stopped. My hormones almost leveled. I am still waiting for my period to return, to find that final piece of relief, the proof that my body is still functioning, even after what felt like betrayal. I will start tracking again, cautiously this time because I am no longer seeing data as truth, only as information. There’s a difference.

The hardest part isn’t the physical recovery; it’s learning to trust my body again. To believe that it hadn’t failed me, that it had done exactly what it was supposed to do: recognize that something wasn’t right and let it go.

Miscarriage doesn’t teach you a lesson; it just rearranges the way you understand control. You stop believing in guarantees. You learn that health isn’t immunity from loss. And yet, somehow, you keep going — walking every morning, eating well, sleeping, living. Healing isn’t dramatic; it’s just the quiet return to ordinary life.

I’ve spent the past decade deeply immersed in health—researching, testing, and living through various protocols. Over that time, I’ve come to recognize which fundamentals really matter and which trends add little (if any) real value. But health isn’t static. Our bodies shift, our lives evolve, and the habits that served us once sometimes need recalibrating. Over the past few months, I’ve made a handful of small changes across training, nutrition, sleep, recovery, and mental health. None were radical, yet each had an outsized impact. Below, I’ll share what I adjusted, why it mattered, and how I measured the results in clear, quantifiable ways.

Training: I increased my weights and lost body fat

I started strength training about four years ago, and it has become one of the most transformative habits in my life. Yes, I’ve gained physical strength, but the deeper shift has been psychological. The gym is a place I genuinely love—a space where even on my hardest days, when I feel anxious or depressed, the simple act of moving weight grounds me. Heavy lifting demands full focus, and that blend of presence and exertion creates a powerful kind of release I haven’t found anywhere else.

When I moved to Austin this spring, I began training with someone new. I was also coming off a stretch of very intense work, which meant I had more energy to invest in my health. I’ve never been afraid of lifting heavy because I understand the science: women won’t “bulk up” unintentionally since testosterone levels are too low, and meaningful muscle gain requires a sustained calorie surplus. Still, I wasn’t sure I was physically capable of pushing my weights much higher. My trainer encouraged me to test that assumption—and she was right.

To track progress, I did a DEXA scan at the start and again three months later. The results surprised me: I gained nearly two pounds of lean muscle, lost three percent body fat and 1.5 pounds of total body weight. For context, during that same period, my hip thrust went from 135 pounds to 225 pounds. If you’ve ever believed women should stick to five-pound dumbbells, let this be a data point: real strength training delivers measurable, meaningful change without making you look like a body-builder.

Note: If you’re starting strength training for the first time, you might feel temporarily puffier or inflamed as your muscles adapt to the (positive) stress of lifting. This is normal. With adequate recovery and without a caloric surplus, your body won’t become bigger or bulkier—only stronger.

Nutrition: I started eating more carbs and changed my breakfast and dinner

Building lean muscle requires more than just progressively lifting heavier weights—it also depends on fueling your body with enough protein and carbohydrates to support muscle repair and growth. For years, I felt best on a lower-carb diet and leaned heavily in that direction. But at my trainer’s encouragement—and with fertility in mind—I began experimenting with adding back more carbs. Carbohydrates play a huge role in hormone health, particularly in supporting progesterone, so it felt like the right time to make this shift.

I still avoid grains like rice and wheat, which leave me lethargic and bloated, but I’ve had great success with starchy vegetables (potatoes, sweet potatoes), fruit, legumes (chickpeas, lentils), and small amounts of oats. Once I started adding a little more of these to each meal, the difference was immediate: I had more energy in the gym and found heavy lifts noticeably easier.

The other major change I made was to breakfast. For years, my default was the good decisions protein smoothie—nutritious, reliable, and easy. But I wanted to see what would happen if I ate something more substantial in the morning, especially since I usually train after breakfast. Here’s what I’ve been eating for the past few months:

Breakfast one: ½ cup grass-fed Greek yogurt with berries and grain-free granola, plus a shake of 1 scoop whey protein, ½ scoop collagen, and 1 teaspoon psyllium husk.

Breakfast two: ½ cup grass-fed Greek yogurt with berries and grain-free granola, plus two eggs.

Breakfast three: ¼ cup overnight gluten-free oats mixed with 1 scoop whey protein, ½ scoop collagen, 1 teaspoon psyllium husk, cinnamon, raw almond milk, topped with Greek yogurt and berries.

Each of these breakfasts delivers ~50 grams of protein, 30–50 grams of carbohydrates, and lots of fiber. They’re also blood-sugar friendly, satiating, and delicious. Breakfast has always been my favorite meal of the day, and leaning into a heartier version has only deepened that joy.

Evenings, on the other hand, are when I’m least hungry. Over the past few months, I’ve naturally gravitated toward smaller, earlier dinners—and the results have been surprising. My HRV (heart rate variability) has increased substantially with this change. HRV is one of the most reliable markers of recovery, resilience, and overall cardiovascular health. No amount of conditioning or cardio has moved my HRV the way this simple dinner shift has. Below is a snapshot of what my weekly HRV trends look like when I keep dinner light and early.

Sleep: I started sleeping more

There’s a certain genre of social media flex built on “thriving” with only five hours of sleep—juggling a full-time job, a Substack, a side hustle, and a packed social calendar. Good for them. But I’d be curious to check back in a decade. If they’re women, what do their hormones and fertility look like? Are they quietly burned out behind the façade? Because while cutting sleep might look like a productivity hack, the truth is it’s a direct path to physical decline and mental erosion over time.

For me, this became impossible to ignore once I started training heavier and became more serious about supporting my long-term health. I used to average around seven hours of sleep, but I’ve shifted closer to eight—sometimes even eight and a half. And no, I don’t feel like I’m missing out. In fact, the opposite: the hours I am awake feel sharper, more productive, and more intentional because I’m well rested. I’m less irritable, less likely to reach for sugar, and more resilient overall.

Yes, I’ve had to cut things out to make this possible. But they were things I won’t miss: late-night scrolling, one more episode of a TV series, or socializing with people I don’t deeply value. The trade-off is obvious—better mood, better focus, and a stronger foundation for both training and fertility. And of course, the data backs it up. My recovery metrics have all improved with this one simple adjustment: sleeping more.

Recovery: I fixed my back pain with a simple habit

I’ve struggled with back pain since my years in ballet school. Because of my natural hyperextension in the lower back, the discomfort never fully went away—and as I got older, it actually became more persistent. Any time I had inflammation in my body, the pain would flare.

For the past six months, I’ve committed to a simple but consistent routine: ten minutes every evening of foam rolling my back and legs, followed by a few mobility exercises with an emphasis on opening up the hip flexors. Paired with a stronger core from my training, this small daily practice has made a huge difference. My back pain has gone from a near-constant presence to something I rarely notice at all—now it only shows up if I’ve been sitting for hours on a long flight or if I’m under the weather.

Mental wellbeing: I unfollowed everyone in the health space

This one might sound extreme, but I’ve stopped following health and wellness creators—and even stopped listening to most of their podcasts—with one exception: Peter Attia. There are two reasons. First, after a certain point the information just becomes repetitive. Once you understand the fundamentals, hearing the same advice in slightly different packaging doesn’t add value.

Second, and more importantly, I’ve noticed a shift in tone. What may have started as a genuine desire to educate often feels like it’s devolved into a game of chasing engagement through fear. You only need to glance at YouTube titles or podcast feeds to see it: ominous headlines designed to trigger anxiety, as if we’re all doomed unless we follow some convoluted 20-step protocol.

This tendency is especially pronounced in the women’s health space—fertility, pregnancy, reproductive health. While it’s valuable that people now share their struggles openly, the balance feels off. The conversation has tilted so heavily toward loss and trauma that it can feel like nobody has positive experiences anymore. Of course those experiences exist, but they’re rarely highlighted.

For me, stepping back from this cycle has been profoundly helpful. Every time I take a break—or better yet, unfollow altogether—I feel calmer, less anxious, and more creative. My thoughts are clearer, my mood lighter. It’s a reminder that we don’t have to invite content into our lives that makes us fearful, especially when those fears aren’t rooted in our own lived reality.

In the end, it’s rarely the dramatic overhauls that endure. It’s the edits made at the margins—the way we eat, train, sleep, recover, and think—that alter the shape of a day and, eventually, a life. These are mine. I’ve recently opened a subscriber chat, and I’d love to read your thoughts, questions, and experiments there.

What I packed

A disclaimer: I am not a light packer, and I cannot travel with a carry-on. But for this trip I packed light—by my standards. Here’s what I actually used over five weeks:

• Supplements: packed in daily pouches. I only brought basics: prenatal, iron, vitamin C, magnesium, probiotics, electrolytes, and protein powder (plus my shaker bottle)

• Books: my iPad loaded with books (and only two paperbacks, a personal victory)

• Swim: two Eres swimsuits and two Hunza G ones

• Shoes: three pairs of Havaianas, one pair of flat sandals, one pair of gym shoes

• Accessories: a sun hat, my huge Row raffia bag (also my travel bag), and three pairs of sunglasses

• Clothing: simple dresses, skirts, and tops—nothing too precious, because I find it tacky to overdress by the beach. All packed in organizing cubes. Two travel outfits (linen pants and cotton sweatshirts) and three workout sets

• Beauty: two full cases because my skin is sensitive and reactive, and I can’t just use “whatever.” Highlights: ISDIN sunscreen, La Roche-Posay calming serum, Shu Uemura shampoo, mask and oil, Defenage serum, Avène Cicalfate (always useful for irritation), Tower 28 face spray, the best sensitive-skin body wash ever made, Necessaire fragrance-free lotion, a Fara Homidi lip liner and oil, and the Hermès bronzer—which I used exactly once

What I saw

• In London: I saw Cartier at the V&A Museum and Jenny Saville at the National Portrait Gallery in London. Both were beautiful, but Saville is one of my all-time favorite artists, and standing in front of her large scale paintings was especially moving.

• In Venice: I revisited the Peggy Guggenheim Collection, which I’ve never found remarkable in terms of the works themselves, but I love the palazzo where Peggy lived—it still feels infused with her spirit. I also stopped by the Pinault Collection, which was a complete miss for me.

• In Paris: Tickets to David Hockey at Foundation Louis Vuitton were sold out, so we went to see Céleste Boursier at the Pinault Collection instead. I left underwhelmed—and a little sad that so many exhibitions today seem designed more for Instagram than for the art itself.

I don’t love trolling museums and galleries just for the sake of it, or to appear cultured. I’ll usually go only if there’s an artist I truly want to see. More often, my favorite thing to do in any city is simply to walk—ideally through the less touristy corners—and marvel at their beauty. Luckily, Europe has no shortage of it.

What I read

• For pleasure: The Brittle Age by Donatella Di Pietrantonio — everything I love in a novel: quiet, introspective, and a beautiful rendering of the complicated but tender bond between mothers and daughters. Baumgartner by Paul Auster — a sublime read that shouldn’t be spoiled with description. Audition by Katie Kitamura — one of my favorite books of 2025 so far, magical and engrossing. Empire of the Elite by Michael Grynbaum — if you grew up loving American magazines, this is a joyful ride through the fantastical world of Condé Nast. The Friday Afternoon Club by Griffin Dunne — a painful but beautiful portrait of a very complicated family. I Regret Almost Everything by Keith McNally — hilarious, heartbreaking, and it made me miss New York even more than I already did.

• For learning: Expecting Better by Emily Oster and The Mayo Clinic Guide to a Healthy Pregnancy — both excellent if you’re considering pregnancy, trying to conceive, or simply curious to understand the process more deeply.

What I watched

• I rewatched The Crown, one of my all-time favorite series. New shows I loved: Lena Dunham’s Too Much and The Gilded Age. Films these days are less inspiring—Materialists felt particularly ridiculous. Because I tend to return to old favorites, I also rewatched The Eye Has to Travel, the classic Diana Vreeland documentary, and Paul Thomas Anderson’s Magnolia—and wondered, yet again, why they don’t make films like that anymore. As for health-related podcasts, I especially enjoyed two Peter Attia episodes: one on longevity and another on female fertility. He’s the only expert in the wellness space I still make time to listen to.

Looking back, the lists are long—things packed, read, watched, seen. But what mattered most wasn’t any of that. It was the time: time to slow down, to notice, to enjoy. A reminder, once again, that the real luxury is not in what we carry, but in how we move through the days—like a morning swim in the sea.

If you asked me to describe perfect happiness, I’d point to a morning swim in the Mediterranean: cool, clear water; blue horizon meeting blue sky. The sea holding me steady, the rare feeling of nothingness and completeness at once. That elusive state mindfulness chases but rarely delivers—being fully present, wanting nothing.

This summer, in Greece, Italy, and Spain, I was lucky enough to live inside that feeling more than once. After three or so years of not taking more than a few days off, Emi and I finally gave ourselves time to slow down: to walk through cities without an agenda, to eat well, to sit with family, and to let days expand.

Along the way, I kept getting questions about how I stay consistent with wellness while traveling, and which places I’d recommend to stay. This post is my attempt to answer: part travelogue, part routine, part reflection on what Americans might learn from Europeans.

On keeping a routine while traveling

For me, nothing sets the tone of a trip more than how I prepare for a long flight. Bringing my own food makes a world of difference in how I feel once I land. Even in business class, airplane food is often heavy, sodium-laden, and reheated in plastic. A small amount of preparation goes a long way.

If I’m leaving from home, I’ll pack simple staples: hard-boiled eggs, a small tub of hummus, raw chopped vegetables, a sandwich with protein and greens, a handful of raw nuts, a piece of fruit, a bar of good dark chocolate, and a scoop of protein powder in a shaker bottle.

When I’m not leaving from home, I’ll stop at a grocery store or health food shop before my flight. The choices vary, but I can always find something: ready-boiled eggs, yogurt, a pre-made sandwich, nuts, fruit, even decent chopped vegetables. It requires a small shift in priority and preparation but it consistently pays off.

My other non-negotiables for long-haul flights are hydration and movement. I drink at least two to three liters of water and I get up every hour to walk the aisle or stretch. I’m always amazed by how many people sit motionless for eight or ten hours. One note on water: buy your own before boarding. Airplane water tanks are notoriously under-cleaned; I avoid hot drinks on planes for this reason.

On arriving at my destination

I don’t try to do it all when it comes to routines. That’s a recipe for failure. I choose a few anchors—sleep, exercise, and eating whole foods—and let the rest go.

For sleep: I aim for eight hours, keep my room dark and cool, take magnesium at night, and, if I’ve crossed time zones, use a small dose of melatonin for the first few nights. Good sleep depends as much on the set-up as the habit. This is why I almost never stay in Airbnbs—too many misses. Hotels are nearly always more reliable. Another reset trick: natural light first thing. Huberman will tell you to get “sun in your eyes”, but I find stepping onto a balcony, sitting by an open window, or taking a short walk does the job. When traveling, more than ever, it pays not to major in the minors.

For movement: if I’m away for weeks at a time, I need a hotel with at least a basic gym—bench, dumbbells, treadmill. I’ll pack a foam roller and resistance bands, which cover everything else. When I train, I usually follow my trainer’s app, but I also like Kirsty Godso’s Pyro. Another great option: GPT. Give it a list of the equipment you have and it will generate a full-body workout with weights, sets, and reps. It never fails to deliver.

But strength training aside, I can’t imagine a day without movement. In cities, I walk everywhere. Near water, I swim. On large resort properties, I’ll walk, take stairs, and skip the buggy rides. The options are endless; the point is to find something you enjoy and do it every day.

Before moving on to food, here are a few hotels I love—places that make it easier to sleep well, move well, and feel at home:

• New York: The Greenwich Hotel has become my home away from home since moving to Austin. Perfect rooms, excellent gym, thoughtful staff, and a location I love.

• London: 1 Hotel Mayfair is my go-to: comfortable, clean, good gym, central. Their West Hollywood property has been my LA standby for years.

• Paris: rooms here are notoriously small. I’ve liked Château Voltaire (good food, no gym) and Hotel Nolinski, but my favorite is Hotel de Crillon—a splurge worth every time.

• Italy: This summer I stayed at two hotels that became instant favorites: Hotel Il Pellicano in Porto Ercole and Hotel de Russie in Rome. Il Pellicano offers what I value most in a beach destination: seclusion. The beach is for guests only, reached by a long flight of stairs that opens onto the clearest water. Swimming there each morning was the highlight of my trip. De Russie, meanwhile, is all about detail and service. The staff are exceptional, and the property feels like a secret garden tucked inside Rome—an entire hidden world apart from the city’s chaos.

  Other Italian all-time favorites: Aman Venice, the Four Seasons Florence and Reschio in Umbria, all places I’ve returned to multiple times.

• Greece: Bill & Coo Mykonos (coast outpost) has private beach access, beautiful rooms, and seclusion. The food was fine, but nearby restaurants more than made up for it—Spilia was a highlight.

• Spain: Cap Rocat in Mallorca, a converted fortress, may be one of the most special places I’ve ever stayed. Breathtaking architecture, sweeping views, clear water, and exceptional food.

On food

Oddly enough, food is the easiest part of wellness for me when I travel. I love eating well, and Europe makes it almost effortless: real, fresh, unprocessed food everywhere you go.

Breakfast is my favorite meal, and this summer I had some of the best of my life. At Il Pellicano, De Russie, and Cap Rocat, the spreads were extraordinary: bowls of fresh fruit, vegetables, eggs, local yogurt and cheeses, raw nuts, honey, olive oil, bread, and regional specialties. Even in hotels without such abundance, I’ll keep it simple—boiled eggs, yogurt, berries, sometimes supplemented with a scoop of protein powder I pack with me. A quick aside on the eggs: in good hotels you don’t have to think twice, but elsewhere scrambled eggs are often made from a mix rather than fresh, and usually cooked in butter or low-quality oils I prefer to avoid.

Lunches and dinners in Italy, Spain, and Greece were equally straightforward: fresh fish, plenty of vegetables drenched in olive oil, good bread. And of course, pasta vongole, tiramisu, and gelato. The food quality in Europe is undeniably superior to the U.S., but the difference is not just in what’s on the plate. It’s also in how people eat.

First, portion size. Europeans eat everything—bread, cheese, meat, dessert, wine—but in reasonable amounts. Plates aren’t overloaded, and it’s common to leave a few bites behind.

Second, the mindset. In Europe, there’s an ease around food, a joy that extends into daily life. Meals linger, often with family. People read books by the beach. Pleasure isn’t treated as a luxury or an indulgence, but as an ordinary, sacred, part of living.

One morning at Il Pellicano I noticed two families that captured this difference. At one table, a French family eating eggs, bread, cheese, fruit, sipping coffee, discussing a book one of the children was reading. They were relaxed, almost languid—and slim by every standard. At another table, an American family, louder, larger, more anxious. The mother asked about gluten- and dairy-free options and filled the table with sad substitutes: soy milk, cornflakes, gluten-free muffins. The contrast spoke volumes.

While America has a food quality problem, the deeper issue is cultural: stress, and a fear-driven health narrative. Stress has become part of the American DNA—life here is harder, yes, but also because being busy and burned out is glorified. And then there’s the fear-mongering, the backbone of the wellness industry. Sugar is evil, dairy is evil, gluten is evil, our homes are toxic, our air is toxic, our land is toxic. We are told we’re all afflicted: some of these conditions are real—autoimmunity, for example, is a genuine and growing problem. But many others are dubious at best: mold toxicity, parasites, and my favorite, the ever-expanding catchall of “generational trauma.”

This is why I find myself increasingly misaligned with the wellness industry. The answer is not endless protocols, supplements, and a constant search for new labels to explain our suffering. More often, the answer is subtraction: less stress, fewer rules, and more time. Time to swim in the sea, to eat real bread and cheese, to sit at the table with people you love.

This post ended up longer than Substack thinks anyone should read in one sitting, so I’ll share the rest later this week: what I packed for five weeks, what I saw and read, and what I watched at 35,000 feet.

When writing about your own health, the hardest thing is not to sound self-pitying. So I’ll stick to the facts.

A few weeks ago, I was at dinner with Emi at one of our favorite restaurants in New York. I picked up my phone to take a photo, saw two missed calls and a voicemail from Ezra, and thought: fuck - I have cancer.

I’m not a hypochondriac. If anything, I lean in the opposite direction. But I’ve done dozens of Ezra scans over the past seven years and I’d never gotten a call before. Not once. The reports were always uneventful, almost boring in their normalcy. I liked that. I liked knowing things about my body. I liked being in an MRI machine. I had the kind of blind faith in my health that tends to come easily when you invest in it daily, deliberately.

Emi saw the panic on my face and told me to call them back.

I didn’t have cancer. But the neuro portion of my scan had picked up something else: a 2mm brain aneurysm.

I stared at my plate. The food looked wrong, inedible. I tried to stay focused, tried to absorb what the Ezra doctor was saying: yes, it was a serious finding. No, I wasn’t in immediate danger. Aneurysms that small have a 0.1% chance of rupturing. I heard that number and nodded as if it meant something - that it was enough. It wasn’t.

I wanted to understand. Why did this happen? How did it happen? What did it mean?

The radiologist who read my scan had recommended a follow-up diagnostic scan in six months. I asked the doctor why I’d wait that long. She agreed - I shouldn’t. As soon as I hung up, I opened ChatGPT and asked it to teach me everything about brain aneurysms. Emi was already texting friends to help us find the best neurologist in New York.

This happened on a Friday, which meant I’d have to wait until Monday to get real answers. For the next 48 hours, I compulsively added bullet points to a new note in my phone titled simply: brain aneurysm.

• What exactly is an aneurysm, and how does it form?

  A bulge or ballooning in the wall of a blood vessel, usually an artery, caused by weakening of the vessel wall. Over time, pressure from blood flow can cause the weakened area to stretch and enlarge, increasing the risk of rupture, which can lead to life-threatening bleeding.
  (I chose to cling to “over time” rather than “life-threatening”.)

• How can we know for sure that this is an aneurysm?

  Medical imaging is the only reliable method. A CT or CTA (Computed Tomography Angiography) would confirm the MRA findings.
  (I knew I wouldn’t be able to get a CTA first thing on Monday but secretly hoped for a miracle.)

• Does its shape and position make it riskier?

  Yes - because mine was located in the anterior communicating artery. This is one of the most common sites of rupture.
  (I didn’t know how to reconcile “common” with “catastrophic.”)

• Can I still lift heavy weights? Do HIIT?

  Avoid any activity that involves straining, breath holds, or spikes in blood pressure.
  (I texted my coach to change my training for the week and felt stupid for mourning my latest lifting PR.)

• What about pregnancy?

  Blood volume increases by 30 to 50 percent during pregnancy, which could theoretically increase risk. Labor and delivery are even more complex - especially if pushing increases intracranial pressure. IVF drugs might also play a role, but there’s no clear consensus.
  (None of this felt like information I could use - it was all conditionals, contingencies, maybes.)

• How can I make sure it doesn’t rupture?

  Monitor for changes in size. Avoid all known risk factors - especially high blood pressure.
  (I started checking mine compulsively: morning, afternoon, evening. Always normal. Still, I checked.)

• Why would I have an aneurysm if I have no family history, never smoked, and have normal blood pressure?

  Some answers said “idiopathic.” Others said “possibly congenital.” One said, bluntly: bad luck.
  (I didn’t like that answer. But it made a kind of intuitive sense.)

• Will I die?

  Not now. But maybe eventually. Maybe suddenly.

  (I didn’t write this one down at first. I didn’t want to make it real. But it was always there.)

I thought information would steady me. That if I could map the mechanisms - blood vessel walls, hemodynamic stress, rupture risk - I could reason my way out of fear. But even as I catalogued everything, I was still inside the fundamental uncertainty: something in my brain might be dangerous, or might be irrelevant.

There’s a particular kind of waiting that isn’t illness, or recovery. Just a suspended state where you’re both fine and not fine. Nothing visibly wrong, and yet something in your brain that could kill you. Or not. You don’t get to know yet.

In those 48 hours, I lived inside that uncertainty. I made coffee. I answered emails. I went to the gym. And quietly, I imagined my funeral - how sudden it would seem, how unfair. The kind of death that makes people say, but she was so healthy.

On Monday morning, we spoke with a radiologist friend. Based on the MRA images, she agreed - it looked like an aneurysm. Another friend referred us to a top neurosurgeon at NYU Langone, one of the leading neurology centers in the country.

There’s a strange kind of hope that blooms in the presence of authority - not in spite of it, but because of it. Even after hearing confirmation from a radiologist, part of me clung to the idea that the next expert might see something different. That with enough credentials, someone could edit the narrative, undo the threat. I wasn’t looking for a second opinion. I was looking for a better one.

And there it was - in the neurosurgeon’s relaxed tone: “We’ll need the CTA first, but it could be nothing.” We spoke on the phone. I found myself pleading - I’m only 35, I’ve never smoked, there’s no family history - and he, politely but firmly, said it didn’t matter. Still, he reassured me: even if it was an aneurysm, something this small wouldn’t require intervention. Just monitoring. A management plan we’d discuss at our appointment.

After a few more phone calls with the neurosurgeon’s office and a stack of intake forms, I finally had an appointment - two weeks out. Plenty of time to think. About how lucky I was to have access to Ezra, to top doctors, to a supportive family. And about how fickle health really is.

I had spent years treating my body like a project - something to refine, optimize, protect. I wore a continuous glucose monitor. I tracked my cycle. I ate well, worked out, slept eight hours. I had quantified nearly everything I could. And yet here was this unquantified thing, tucked into an artery in my brain, discovered not because of a symptom but by accident. It felt like a betrayal - not just of my body, but of the entire premise that effort creates immunity. That if I just did everything right, I could stay ahead of chaos.

But that’s the reality of the body. It doesn’t always submit. It lives out its own version of events, often in direct contradiction to how we see ourselves.

Mentally, I oscillated between feeling like I had a ticking bomb in my skull and moments of forgetting entirely, like a phone left on silent.

A few days before my appointment, I got a call: the neurosurgeon would be in surgery and wouldn’t be able to see me. I could still do the CTA, but no consult - more waiting. And waiting is not something I’m good at. It only expands my capacity for adding questions to an already embarrassingly long list.

But by the time I made it through the freezing corridors of NYU Langone, I was calmer than I’d been in weeks. Unlike most people, I like hospitals. I like observing how quickly doctors and nurses move. The protocol and precision feel soothing to someone so tethered to control like me. I’m also fascinated by the human body - and the systems we’ve built to study, treat, and care for it. Admittedly, I’d never been sick enough to see the other side of that fascination. To feel it as a patient. To experience the medical system not as theory, but as scaffolding you have to lean against. I counted my blessings again. Most people don’t get a second scan. Or a neurosurgeon’s cell phone. I was lucky, and I know it.

Once I was lying on the table, IV in, contrast fluid sending hot flashes through my body, sadness crept in. Maybe it was self-indulgent, but I didn’t want to live with this. I didn’t want to know there was something inside me that could - even if unlikely - one day kill me. I didn’t want to change my lifestyle. I didn’t want to stop doing the things that made me feel good (like hard workouts) or be afraid of delivering a baby someday. I didn’t want to live in fear.

A CTA, however, is over faster than I can run through all the worst-case scenarios (my ability is uncanny), so I got up and left with nothing but the metallic taste of contrast in my mouth. Emi had told me that radiologists prioritize CTs over MRIs and other modalities, so I knew the results would come quickly.

A few hours later, I was on the treadmill, trying to sweat out the contrast, when I got the text. My results were in. I read the report three times just to make sure I wasn’t misunderstanding. But the words were clear: I did not have an aneurysm. Instead, I had a congenital fenestration - an artery that splits into two before rejoining. I ran upstairs and showed Emi the report. It was the best news I’d gotten in a long time. Maybe ever. I joked that a congenital split artery felt appropriate for someone who often felt like she had multiple personalities.

I still needed to speak with the neurosurgeon, but the fear had evaporated. No more ticking bomb. No more waiting.

When we spoke, he confirmed the result. The split creates a small bulge, which on an MRI can look almost identical to an aneurysm. That’s exactly why a second, diagnostic scan is always needed with findings like these. I still had questions, and he obliged. No, the fenestration wouldn’t increase my risk of developing an aneurysm. Yes, I could work out, travel, have babies, do everything I wanted to do. It was probably always there, he said. And it will continue to be there. Forget you have it.

But I didn’t want to forget it. I wanted to write about it.

This is what the medical world calls an “incidental finding” - something discovered during a scan meant to screen for something else. It’s one reason some doctors discourage proactive scans like Ezra. They argue it causes unnecessary anxiety, that the emotional toll of a potential false positive isn’t worth it if the finding turns out to be benign.

I disagree. A few weeks of anxiety is a small price to pay for clarity. What if it had been an aneurysm? The best outcome is not having one. The second best is knowing that you do. More than half of people whose aneurysms rupture, die. Many never knew they had one. But if you do, you likely won’t die from it. You’ll have time. You’ll have choices.

I’ve always said that the small, daily habits - the food we eat, the way we move, how we sleep, how we care for our minds - shape our long-term health. That will always be true. But prevention is part of the equation too. Lab tests, cancer screenings, mammograms, colonoscopies - all the things we don’t want to schedule, that someone has discouraged us from doing, that feel like too much hassle. Those are the things that save lives.

There are really only two outcomes: you find something early and get to act. Or you find nothing, maybe with a detour like mine. But either way, you return to your life. With relief. With peace. Or, as my doctor put it: forget all about it.

Intro

I first became aware of the impact of environmental toxins and microplastics about seven years ago, when I started working with my primary care physician at Parsley Health. Back then, the conversation around these toxins largely centered on their potential role as endocrine disruptors and their effects on hormonal and reproductive health. It was a niche topic in the health and wellness space, and I can’t recall meeting anyone else who had undergone bloodwork to assess their toxin burden.

Fast forward to 2025, and toxins and plastics have become the new sugar—blamed for everything from declining fertility rates to poor metabolic health and even cancer. While I have no intention of fueling the fear-mongering often seen in the wellness community, I’d like to present a brief explanation of what these substances are, how much exposure we really face, and the practical steps we can take to minimize their impact on our health.

Toxins vs. microplastics

The terms “environmental toxins” and “microplastics” are often used together, but they refer to distinct categories of harmful substances. Environmental toxins encompass a broad range of chemicals and pollutants found in our air, water, soil, and household products. These include heavy metals like mercury and lead, pesticides, industrial chemicals such as PCBs, and volatile organic compounds (VOCs). They can infiltrate our bodies through the air we breathe, the food we eat, and the products we use daily.

Microplastics, on the other hand, are tiny plastic particles—less than 5 millimeters in size—that result from the breakdown of larger plastic waste or are intentionally produced for use in products like cosmetics. While microplastics themselves are a physical pollutant, they often act as carriers for environmental toxins, binding to harmful chemicals and introducing them into ecosystems and our bodies.

Is the world really that toxic?

Current research indicates that environmental toxins and microplastics are pervasive and widespread in our environment and bodies:

• Pesticides like glyphosate are commonly detected in fruits and vegetables, while phthalates and bisphenol A (BPA), widely used in plastics, are regularly found in human urine samples. Biomonitoring studies by the CDC have detected measurable levels of toxic substances, including heavy metals like lead and mercury, in most of the population, including newborns.

• Microplastics have been detected in air, water, soil, and throughout the food chain. They have been found in remote areas like Antarctica and the bottom of the Atlantic Ocean.

• It's estimated that the average person ingests 39,000-52,000 microplastic particles per year through food and drink. Microplastics have been detected in human blood, brains, placentas, breast milk, and various organs like the heart, liver, and kidneys.

Perhaps the most interesting read of the new year has been the research published by Nat Friedman on the Plasticlist. Nat assembled a team of four people to conduct this extensive study and investigate the presence of plastic-related chemicals in everyday foods. Their interest was sparked by recent discussions about Endocrine Disrupting Chemicals (EDCs) and their potential health impacts. The team tested nearly 300 food products for 18 different plastic-related chemicals, including phthalates, bisphenols, and phthalate substitutes. They collected samples from various sources, including grocery stores, restaurants, and even vintage foods from past decades. The study cost about $500,000 and took six months to complete. Here are some of the most interesting findings:

• Plastic chemicals were detected in 86% of the foods tested, with at least one chemical found in every baby food, prenatal supplement, breast milk, yogurt, and ice cream product. Shockingly, “healthy” foods such as RX bars and Sweetgreen salads were the top two most contaminated products.

  

  Here’s a telling snippet:

  • Plastic chemicals were in practically all the upscale and healthy products we tested; we tested raw milk and beef straight from the farm, 22 organic foods, and 20 healthy groceries from Whole Foods. Apart from O Organics eggs, all of those products contained plastic chemicals.

• Less-processed foods generally contained fewer chemicals than heavily-processed ones.

• Hot foods left in takeout containers for 45 minutes showed 34% higher levels of plastic chemicals compared to the same dishes tested directly from the restaurant.

• Water testing revealed surprising results, with some tap water samples showing higher chemical levels than bottled water, and no significant difference between water in plastic and glass bottles. In fact, my favorite brand of water (Mountain Valley) that comes in glass bottles was more contaminated than water from plastic bottles.

• Vintage foods from past decades contained different chemical profiles compared to modern foods, with older samples showing higher levels of original phthalates and newer samples containing more phthalate substitutes.

• Thermal receipt paper contained extremely high levels of bisphenols, particularly BPS.

These results represent point-in-time measurements of a small number of product samples and may not be representative of actual product contents. However, even when accounting for the study’s limitations, this is still a thorough analysis that can be used as a starting point for broader-scale initiatives.

How worried should you be?

So if the world is literally infused with toxins and microplastics, how bad is it for our health? The honest answer is we don’t fully know. Many studies have demonstrated various toxic effects, including oxidative stress, inflammatory lesions, DNA damage, and organ dysfunction. We also have evidence that microplastics may cause metabolic disturbances, neurotoxicity, and increased cancer risk among others. But we lack clear guidelines on the level of exposure that increases our risk of developing these health problems.

An interesting finding in Nat’s study is that the evidence suggests plastic chemicals may be particularly harmful to fetal and infant development, with early-life exposure to hormonal disruption potentially leading to lifelong effects. For example, exposure to phthalates is associated with a 20% higher rate of childhood cancer overall, with nearly three-fold higher rates of bone cancer and two-fold higher rates of lymphoma.

Babies have sensitive hormones, developing immune systems, and growing bodies, which makes them more susceptible to the toxic impacts of plastic. Unfortunately exposure is extremely widespread as they ingest microplastics through various sources, including breast milk, formula prepared in plastic bottles, and exploration of their environment (including toys, baby products and playgrounds).

Practical solutions

At this point, striving for a “toxin-free” lifestyle is pure wishful thinking. That doesn’t mean we should throw our hands up and keep microwaving food in plastic containers, though. Instead, we can focus on what’s within our control and recognize that there are bigger levers to pull for our health—like exercise, sleep and nutrition —rather than obsessing over which “non-toxic” yoga pants to wear.

Once microplastics and toxins enter the body, complete detoxification is challenging, but there are some ways the body may eliminate them and strategies that could help:

1. Sweating - either through vigorous exercise or sauna.

2. Excretion - through feces and urine. An important part of optimizing excretion is drinking enough water and improving digestion by eating a lot of fiber (vegetables, fruit, seeds, psyllium, flax, etc.) that not only improve regularity but also help bind and pull toxins out of the body. Eating probiotic (fermented foods) is another tool for improving gut health and enhancing digestion.

3. Removal by the liver and spleen. You can support healthy liver function in a few different ways including consuming foods like cruciferous vegetables and leafy greens, supplementing with glutathione to boost the liver's detoxification capacity and finally reducing alcohol and processed foods consumption to lessen the burden on your liver.

Extreme measures often promoted on social media—like juice cleanses, colonics, activated charcoal products, ozone therapy, or lymphatic massages—lack strong evidence to support their effectiveness. If you focus on optimizing your body’s primary functions as described above, these additional practices might contribute, at best, 5% to your overall efforts.

In terms of reducing your exposure to toxins and microplastics, given their ubiquity, the best approach is to prioritize the areas you have most control over:

1. Water filtration in your home. Consider reverse osmosis or activated carbon filters, which can remove microplastics and other pollutants. I’ve used AquaTru for years.

2. Air quality in your home. Vacuum regularly using a HEPA filter to remove contaminants from your home and invest in an air filtration system to reduce airborne particles. I have a Coway purifier in every room in my house.

3. Food storage and preparation. Avoid heating food in plastic containers or with plastic wrap, as heat accelerates chemical leaching. Use glass, stainless steel, or ceramic containers instead of plastic for food storage.

4. Eating whole foods. Yes, microplastics have now been found even in organic produce and grass-fed meats. However, whole foods are still lower in toxins and microplastics than processed foods (packaged snacks, fast food, etc.), so making those the bulk of your diet will not only reduce your exposure, but also give you the nutrients needed to nourish your body.

5. Limit exposure in small ways such as: avoid touching thermal paper receipts (go paperless or wash your hands after), replace conventional household cleaning products with less toxic ones or use a mask and gloves when cleaning, replace non-stick cookware with stainless steel, cast iron, or ceramic.

If you have babies or small children, the two areas where you can make the biggest impact are their nutrition and the toys and baby products they’re exposed to. The same principles apply to them as to adults: focus on feeding them whole, unprocessed foods from the start (including high-quality formula, if needed), and replace plastic products with alternatives made from glass, stainless steel, silicone, wood, or natural fibers.

I intentionally left out personal care products and clothing because “clean” labels can be misleading, and I don’t want to promote extreme optimization. As long as you’re taking the steps outlined above to create a healthier home environment, reduce unnecessary exposure, and prioritize the basics, you’re on the right track. Yes, you might still ingest a bit of microplastic with your organic salad or grass-fed steak, but a resilient, healthy body can handle it.

I’m writing this post from the back of an Uber on my way to my first day at a new job. This isn’t just any job, though—it's a dream role at a dream company. But before I spill the details, I want to tell you how I ended up here.

Earlier this summer, I got an email that completely caught me off guard. The founder of an incredible company reached out, asking if I’d be interested in chatting about a role they were opening up. How did they even know who I was? We happened to run in the same health & tech circles and he had read my Substack. Serendipitous moments like these are rare, but this experience reaffirmed my belief in the value of only putting your best work out there. I remember when a bunch of people told me to shift my focus to TikTok and Instagram because "no one has the attention span for blogs anymore." Turns out, the people who matter still do.

For the past four years, I've been fully immersed in my own startup, with no intention of joining another company. Not because I was clinging to the "founder" title, but because there just aren't many innovative companies in the health space that align with my my vision. My mission is to help people live healthier lives, and that’s what brings me the most satisfaction. There are many paths to achieving that mission—starting my own business was one, but joining a company already making strides in this area, with an even more exciting vision for the future, is another.

I’m thrilled to share that, as of today, I’ve joined Eight Sleep as the Director of Special Projects. I’ll be working with the team to launch some exciting new products—if you want a hint about what’s on the horizon, check out Packy’s piece here. As a customer who already loved Eight Sleep's product and brand, meeting the team and hearing about their long-term vision made me even more excited to be a part of it.

Eight Sleep’s current hero product, the Pod, has already had a significant impact on my life. I've written before about how it’s helped me improve my sleep. But what's coming next is going to elevate people’s sleep fitness—and overall health—to a whole new level. The new products I’ll be helping to launch perfectly align with what I’ve been working on for the past few years. What also resonates with me is the company’s approach to product development. Everything Eight Sleep builds is evidence-based and backed by extensive data. Thanks to the product's ability to continuously measure biometrics for many hours each night, we have a unique advantage—being able to run a vast number of tests and studies that few other companies can match.

Beyond the product and brand, what truly convinced me to join the company was meeting the team and getting a taste of the culture. From the incredibly rigorous interview process to the caliber of every single person I spoke with, it's impossible not to be energized by such a high level of quality. Huge kudos to Matteo and Alexandra for building this team.

I feel very grateful and excited for the opportunity to work on something I love, alongside amazing people, as part of a super fast growing company at the forefront of health and technology. The next few months are going to be intense - in the best way possible - but I’ll do my best to keep up with my posting schedule here on Substack. I’m certain I’ll learn a ton and have even more health and wellness insights to share. As for those wondering about good decisions, don’t worry - it’s in good hands and I’ll update you soon.

Intro

Although much of today's health and wellness discussion takes place on social media, I’ve felt a growing urge to distance myself from it. We’ve reached a point where misinformation is so rampant that it feels safe to assume 90% of what you see is inaccurate. The first issue is that everyone claims to be an expert. With countless fabricated credentials, it's easy to be misled by “longevity experts,” “brain health coaches,” “holistic coaches,” and the like.

I don’t believe you need to be a physician or hold a PhD to be knowledgeable about health—I only have a nutrition certification. But I’ve been studying health for over a decade and have developed a rigorous framework for how and why I share information. This brings me to the second issue: social media is flooded with opinions, preferences, and, at best, anecdotes. I may not be a scholar, but I’ve learned how to use evidence to inform my views. There’s a significant difference between personal opinion, an article in the New York Times, an observational study with 10 participants, and a meta-analysis of randomized controlled trials. Until more people can at least distinguish between these, I would refrain from taking their advice.

As much as I’ve preferred not to engage on social media, it’s been impossible to ignore the latest claims and “trends” that flood every other Instagram reel or TikTok video. Since my mission is to help people become healthier by making evidence-backed information more digestible, I’ve chosen a few of these health fads to address. For each, I’ll provide a straightforward paragraph that summarizes the evidence to easily dismantle the false claims. At the end of this post, I’ll also share a couple of tools that can help you verify any health claim in just a few minutes.

1. “Due to non-toxic living, I have the fertility of a 20-year-old at 35.”

If you’ve read my series on fertility, you know that the one absolute certainty we have about female fertility is that it declines with age. We are born with all the eggs we will ever have—approximately 1-2 million. By age 30, we’re left with around 120,000 eggs, and by 51, women have fewer than 1,000 eggs remaining in their ovaries. We also know that egg quality is just as important for fertility as egg quantity. Smoking, alcohol, and exposure to chemicals that disrupt endocrine function negatively impact egg quality. However, since no test can measure egg quality, there is no reliable way to gauge a woman’s fertility from an egg-quality standpoint other than her ability to conceive. So, if fertility declines with age for all of us, and there is no test to measure egg quality, the claim that someone has “better fertility” in their 30s compared to someone in their 20s is completely false.

2. A toxin-free lifestyle is better for health.

Speaking of toxins, you might have seen wellness influencers promote “clean beauty”, “non-toxic” cookware and all sorts of products meant to stave off everything from hormonal imbalances to cancer. Environmental toxins can significantly impact human health, but there is limited scientific evidence supporting health benefits from using "clean" beauty products or “clean” cookware. However, endocrine disruptors from plastics and pesticides do affect hormone health. Heavy metals and industrial chemicals that contaminate drinking water, food sources, and the air we breathe have been linked to decreased fertility in both men and women. To mitigate these risks, here’s what to focus on: drink the cleanest water you can, use air purifier to improve air quality, consume organic produce if you can afford it, don’t eat and drink from plastic, don’t smoke and reduce alcohol consumption.

3. EMFs are bad for health.

The health effects of electromagnetic fields (EMFs) have been a subject of ongoing research and debate, but there is limited evidence to conclusively support that EMFs are detrimental for human health. EMFs in a household primarily come from electrical appliances, wiring, electronic devices, and wireless technologies like Wi-Fi routers and cell phones. Some studies have suggested possible links between EMF exposure and:

• Childhood leukemia (for extremely low frequency EMFs)

• Cognitive effects similar to Alzheimer's disease (in animal studies)

• Symptoms like headaches, sleep disturbances, and fatigue

However, many of these findings are inconclusive or require further research to confirm. The World Health Organization (WHO) states that current scientific evidence does not confirm the existence of any health consequences from exposure to low-level electromagnetic fields.

4. Cortisol gives you a “puffy face”.

High cortisol levels are associated with obesity and metabolic syndrome. However, it’s not cortisol itself that directly causes weight gain, but rather the stress-induced consumption of high-fat and high-sugar foods that leads to a caloric surplus. Elevated cortisol can increase appetite, raise blood sugar and insulin levels, and slow down metabolism. When it comes to fat distribution, chronically elevated cortisol is linked to increased abdominal and visceral fat accumulation, rather than facial changes. One of the few instances where cortisol and facial swelling are interconnected is in Cushing syndrome. Unless you suffer from Cushing, a puffy face is more likely related to water retention from processed foods or alcohol, lack of sleep, allergies, or thyroid problems.

5. Seed oils are bad for health.

Currently, there is limited scientific evidence to support claims that seed oils are inherently bad for health. A randomized controlled trial found no significant differences in cardiovascular health markers between groups consuming rapeseed oil, sunflower oil, or a control diet over 12 weeks. High consumption of omega-6 fatty acids may contribute to inflammation and oxidative stress, but moderate intake of seed oils appears to be safe and potentially beneficial when balanced with omega-3 fatty acids. However, many health concerns associated with seed oils are likely due to their presence in processed foods, which have other unhealthy components. If you want to minimize consumption of “unhealthy oils”, avoid deep-fryers in restaurants where the oil isn’t changed often, and processed foods which are high in refined carbohydrates, sugar and sodium, along with seed oils.

6. Hormonal birth control is carcinogenic.

In recent years, I’ve noticed a trend encouraging women to avoid hormonal birth control (oral contraceptives) for various reasons, often aligned with the “non-toxic” lifestyle movement described above. While I strongly advocate for women to be fully informed and make empowered decisions about their bodies, it’s important to clarify the link between hormonal birth control and cancer risks. As of 2024, The National Cancer Institute clearly states that “nearly all the research on the link between oral contraceptives and cancer risk comes from observational studies which cannot definitively establish that an exposure—in this case, oral contraceptives—causes (or prevents) cancer.”

Some studies show a slight increased risk (20-30%) of breast cancer with COC use, particularly for current or recent users. This increased risk appears to be temporary and declines after stopping use. The absolute increase in breast cancer risk is very small, especially for younger women.

There is a slightly increased risk of cervical cancer with COC use, especially with long-term use (over 5 years). This risk declines after stopping use and returns to normal within 10 years.

When it comes to ovarian, endometrial and colorectal cancer, COC use is associated with a significant reduction in risk for these types of cancers. This protective effect can last for decades after stopping use. The risk reduction is estimated to be about 50% for ovarian cancer, 30% for endometrial cancer, and 15-20% and for colorectal cancer.

In conclusion, while hormonal contraceptives may slightly increase the risk of certain cancers (breast, cervical), they also provide significant protective effects against others (ovarian, endometrial). The overall cancer risk does not appear to be significantly altered. The decision to use hormonal contraceptives should be made on an individual basis, considering personal and family health history.

7. Women need more sleep than men.

Throughout their lives, women face a higher risk of developing insomnia. Hormonal factors, including menstrual cycles, pregnancy, and menopause, can significantly impact women's sleep. Women also show a more pronounced response to sleep deprivation, with divergent consequences for multiple physiological systems compared to men. But even though women’s sleep architecture differs, at a biological level, there is no evidence to show that women need more sleep than men.

8. All plants have amino acids.

This claim is often made by people who eat a plant-based diet and want to prove that you don’t need to consume animal protein in order to get the necessary amino acids for healthy nutrition. While it is true that all plants contain amino acids, not all plant proteins are considered "complete proteins." Some plant sources like quinoa, soy, and buckwheat are complete proteins, however, the main difference between plant and animal proteins is often the balance or proportion of amino acids, not their presence or absence. For example, you would need to eat three cups of quinoa to get the same amount of protein and amino acids as three ounces of chicken (about 30 grams of protein). But the three cups of quinoa also come with over 100 grams of carbs and 650 calories, versus 0 carbs and 140 calories from chicken.

9. HIIT is bad because it raises cortisol.

As with many of the previous claims, this one also tends to hurt women the most. If we look at the scientific literature, high-intensity interval training (HIIT) has, in fact, shown many positive effects for women's health. Studies indicate that HIIT can significantly improve cardiorespiratory fitness in women across different age groups, effectively reduce body weight, total fat mass, and abdominal fat mass in both pre- and postmenopausal women. In overweight young women, HIIT has demonstrated superior results compared to moderate-intensity continuous training in improving body composition, cardiac function, and aerobic capacity. Women naturally have more oxidative (Type 1) muscle fibers, greater fatigue-resistant muscles, and a higher reliance on fat metabolism compared to men, which make them perfect candidates for HIIT workouts.

Acute stress is a short-term response to immediate challenges or threats, while chronic stress is a prolonged state of stress that persists over an extended period due to ongoing pressures or unresolved issues. HIIT does increase cortisol acutely, but regular exercise leads to reduced baseline cortisol levels and improved stress resilience which means everybody - women and men alike will see numerous health and longevity benefits from high intensity training.

10. The carnivore diet is good for hormone health.

I’ve come across social media accounts with hundreds of thousands of followers claiming that a carnivore diet has helped with “hormone balance” and irregular periods. First, the term “hormone balance” is often thrown around, but it’s a vague concept that can mean different things to different people at various stages of their lives. There are two main ways in which a carnivore diet might support healthy hormonal function: it’s high in fat, which is an essential building block for hormone production. If someone hasn’t been consuming enough fats, it can negatively impact multiple endocrine functions. The other mechanism is the reduction in carbohydrate intake. Lower carb consumption can reduce insulin levels, which may help with conditions like polycystic ovarian syndrome (PCOS) by lowering both insulin and testosterone levels.

However, these benefits can also be achieved by simply consuming an appropriate amount of healthy fats and reducing carbohydrate intake—without the need for a carnivore diet. The danger of this diet lies in the complete removal of fiber, which can have a detrimental effect on the gut microbiome and, consequently, on hormone health. The estrogen-gut microbiome axis has implications for multiple aspects of women's health, including obesity, metabolic syndrome, cardiovascular disease, and cognitive function.

Tools to help you verify health information

As promised at the start, I’d like to offer a few simple ways to help you navigate the health and wellness misinformation you’re likely to encounter. First, always check an expert’s credentials and methodology. A large following doesn’t equate to being qualified to offer advice, and if their guidance is based solely on opinions or personal anecdotes, it’s wise to question it. Second, for any claim that an intervention—whether it’s related to nutrition, exercise, supplements, or something else—affects health, you can consult the scientific literature to see if there’s evidence supporting it.

I understand that spending hours reading research papers isn’t most people’s idea of fun, which is where tools like Elicit and Consensus come in handy. These AI-powered search engines draw from hundreds of millions of academic research papers across all disciplines, making it incredibly easy to find research-backed answers to your questions while also highlighting the underlying scientific knowledge and sources. Personally, I’m so excited to be living in a time when technology makes complex information more accessible and easier to understand.

Intro

If you want to learn more about the the unprecedented rise in obesity and the current gold-standard treatments, read part one of this series here. In part two, I will share data on how we approach prevention today and why I believe focusing on child obesity could be one of the most powerful interventions to date.

Obesity prevention today

The WHO Acceleration Plan to Stop Obesity states that:

Overweight and obesity are largely preventable, but tackling obesity must be recognized first as a societal rather than an individual responsibility with the solutions to be found through the creation of supportive environments and communities that embed healthy diets and regular physical activity as the most accessible, available and affordable behaviors of daily life.

So far, unfortunately, prevention efforts have struggled to keep pace with rising obesity rates. As of today, no country is on track to achieve the global nutrition target to stop the rise in overweight and obesity among children under 5, nor to achieve the global non-communicable disease target to stop obesity among adolescents and adults. This failure can largely be attributed to government policy, public health, and the medical system, but not only to these domains.

Shifting the responsibility and blame from individuals to society has positive implications, such as recognizing obesity as a disease, which can lead to appropriate treatment and reduced stigma. However, implementing effective, large-scale policies is a long and complex process. Without individual accountability, overcoming the obesity crisis may never be possible.

There are two primary reasons to focus on addressing childhood obesity. First, children and teenagers who are overweight or obese are significantly more likely to remain obese into adulthood compared to their peers with a normal BMI. Second, as explained in part one of this series, it becomes more challenging for these individuals to lose weight once they reach adulthood. While new medications, such as GLP-1 receptor agonists, and bariatric surgeries can successfully treat obesity and related health issues, these treatments come with both financial and health-related costs.

What contributes to child obesity

The rise in childhood obesity has seen a dramatic increase over the past few decades. According to the NCD Risk Factor Collaboration, in 2022, 65.1 million girls and 94.2 million boys aged 5-19 were living with obesity worldwide. The global prevalence of obesity in girls increased from 1.7% in 1990 to 6.9% in 2022, and from 2.1% to 9.3% in boys during the same period.

The main risk factor associated with being overweight as a child is the increased likelihood of developing obesity as an adult. Childhood obesity also leads to higher chances of developing type 2 diabetes, cardiovascular diseases, and psychological issues, which can persist into adulthood.

The rise in childhood obesity rates is attributed to a number of interconnected factors. Sedentary lifestyles, unhealthy eating patterns, increased screen time, as well as socioeconomic and psychological factors are the main contributors.

Lack of physical activity

It is recommended that children and adolescents aged 6–17 years should achieve ≥ 60 minutes of physical activity each day. Unfortunately, only 21.6% of children 6–19 years reach the recommended 60 minutes of physical activity at least five days per week.

The link between reduced physical activity and weight gain was most evident during the COVID-19 pandemic when obesity rates among children aged 7 to 9 increased. A 2024 WHO/Europe report, conducted across 17 European countries with over 50,000 children participating, revealed that the pandemic led to more screen time and 30% less physical activity compared to the pre-pandemic period. This reduction in activity was accompanied by an increase in the number of overweight children in the same age group.

Poor nutrition

Children's diets have shifted towards higher consumption of calorie-dense, nutrient-poor foods. The availability and marketing of fast food, sugary snacks, and beverages have increased, leading to higher calorie intake without corresponding nutritional benefits. The WHO European Childhood Obesity Surveillance Initiative analyzed over 132,489 diets of children across 23 European countries and reported that fewer than half (42.5 %) consumed fruit and less than a quarter (22.6 %) consumed fresh vegetables daily.

Increased screen time

According to the Centers for Disease Control and Prevention (CDC), children in the United States spend an average of the following (shocking) hours per day in front of screens, depending on their age:

• 8–10 years old: 6 hours

• 11–14 years old: 9 hours

• 15–18 years old: 7.5 hours

Aside from its impact on obesity and cardiometabolic issues, average daily screen time is now considered an independent risk factor for disease and it has been linked to delayed cognitive development and increased depression among adolescents.

Socioeconomic factors

Children from lower-income households are more likely to be obese. Economic constraints can limit access to healthy foods and safe environments for physical activity. In the US, there are disparities in obesity rates among different racial and ethnic groups, with higher prevalence observed in Hispanic and Black children compared to their White and Asian peers.

The environment in which children live, including their home, school, and community, influences their eating and activity behaviors. Factors such as the availability of recreational spaces, community safety, and school policies on nutrition and physical activity also impact a child's risk of becoming obese.

Psychological factors

In a study exploring the connection between stress and childhood obesity, stress is identified as a key factor in both contributing to and perpetuating obesity in children. Children who are obese are more likely to encounter stress at home, and this daily stress can significantly influence their eating habits. Often, food becomes a coping mechanism for managing stress, anxiety, or other negative emotions, which can create a cycle where eating is linked to emotional relief.

A potential connection to the stress response is poor emotional regulation. In this context, a child's actions and behaviors are influenced by their emotions, how they experience them, and how they express them to others. Ineffective emotional regulation has been linked to stress and obesity, indicating that stress combined with poor emotional regulation can lead to unhealthy eating behaviors like emotional eating and other maladaptive behaviors such as sleep difficulties or decreased physical activity.

How to prevent child obesity

Evidence supports a multi-component, collaborative approach as the most effective prevention strategy. This approach involves societal measures, community and school programs, primary healthcare, and home/family-based interventions that integrate both physical activity and diet. Some interventions, such as preventative screenings, regular BMI assessments, and counseling sessions to educate families on healthy lifestyle choices, are easier to implement. In contrast, at-scale policy changes are more complex, expensive, and take longer to set in motion. Regardless of the type of intervention, the data clearly indicates one influential factor: parents have the power to adopt daily, evidence-backed practices that can significantly impact their children’s health.

Societal measures

The WHO Acceleration Plan to Stop Obesity proposes the following at-scale solutions:

• Front-of-Pack Nutrition Labels: implementing clear and effective labeling to help consumers make healthier food choices.

• Restrictions on Marketing: limiting the marketing of unhealthy foods and beverages, particularly to children.

• Fiscal Measures: utilizing taxes and subsidies to reduce the consumption of ultra-processed foods and beverages.

• Healthcare Services: providing comprehensive services for the prevention and management of obesity within healthcare systems

Studies indicate that Front-of-Pack Nutrition Labels (FOPNLs) such as the Guideline Daily Amounts (GDA), Traffic Light System (TLS), and specially designed labels can help children identify healthier snack options. The magnitude of improvements, however, is often small and context-dependent. For example, in France, the Nutri-Score label has shown positive effects on consumer purchasing behaviors, but these effects are modest.

Marketing restrictions have been shown to decrease the appeal of unhealthy foods to children, potentially reducing their consumption. Countries like Chile have implemented strict regulations on marketing unhealthy foods to children, including bans on advertising during children's programming and restrictions on using cartoon characters on packaging. However, comprehensive data on the direct impact on obesity rates in children is still emerging.

As of 2024, around 50 countries or jurisdictions have implemented taxes on sugary drinks. In the UK, for example, the sugar taxes on sugar-sweetened beverages (SSBs) led to a 28.8% reduction in sugar content of taxed beverages between 2015 and 2018. While reductions in SSB consumption are a positive step towards addressing obesity, the direct impact on childhood obesity rates is more challenging to measure in the short term. Long-term studies are needed to assess the full impact of these fiscal measures on obesity trends.

The implementation of such measures is even more critical in low economic status countries experiencing the fastest rise in obesity levels. The WHO timeline for achieving significant impact is set for 2030, with mid-term targets in 2025. However, no member state in the European Region is on track to reach the target of halting the rise in obesity by 2025. Societal measures alone cannot be the sole solution.

School and community measures

Some of the most effective school-based interventions include:

• healthy nutritional behavior education, physical activity, and involvement of the parents

• increasing the number of hours for physical education in schools and the development of extensive motor skills starting at a pre-school age

• improvement of the quality of the catering offerings and removing vending machines

• reducing the consumption of sugared beverages by offering drinking fountains

School-based prevention programs are effective in combating obesity due to the consistent interaction between children and teachers, especially when teachers act as role-models and get actively involved in health-promoting activities. These programs can blend behavior-focused strategies, such as nutritional education and promoting physical activity during regular classes, with environment-focused measures. This combination includes providing supportive facilities within the school setting, such as playgrounds, drinking fountains, healthy school meals, and nutritious snacks.

It has been shown that school-based programs offered for more than 1 year have the most beneficial effect on weight status and that combining nutritional education with an increase of physical activity leads to better outcomes. Focusing solely on nutrition or physical activity diminishes the effects.

Among the most relevant predictors for positive outcomes are the strong involvement of the parents. In Denmark, for example, which has one of the lowest rates of child obesity in Europe, there is no national school meal program, and most primary school children bring packed lunches from home. Some municipalities, like Copenhagen, have invested in school meals, which are paid for or partially paid for by parents. These meals are mostly organic and include dishes like salmon, pasta, porridge, and curry, with a focus on vegetarian options and minimal red meat. Snacks often consist of healthy grains and greens, such as dark rye bread, homemade rolls, fruits, or vegetables.

Home interventions

Research shows that the home environment is one of the most powerful influences on children’s healthy behaviors and overweight/obesity outcomes. Early childhood presents a unique opportunity to establish healthy lifestyle behaviors, such as good eating habits, regular physical activity, and limited sedentary time. This is particularly important because childhood obesity often continues into adulthood, with overweight preschool children being more likely to become overweight adults compared to their peers who maintain a normal weight.

At an individual level, parents can adopt preventive interventions at each step of the life cycle, starting from pre-conception and continuing during the early years. These include:

• Perinatal: mother’s weight, adequate prenatal nutrition, healthy blood sugar levels during pregnancy, adequate postpartum weight loss

• Infancy: exclusive breastfeeding for the first 6 months followed by inclusion of solid foods, providing a balanced diet with avoidance of calorie-rich, processed snacks

• Preschool: model healthy food preferences by giving early experience of different foods and flavors, encourage behaviors around healthy eating, physical activity and sleep hygiene regardless of current weight status, monitor the rate of weight gain

• Childhood: monitor weight and height, continue encouraging the healthy behaviors from above with an emphasis on physical activity, limit consumption of sugar sweetened beverages and energy-dense foods, limit screen time, support emotional self-regulation

• Adolescence: as above, with an emphasis on preventing the increase in weight after growth spurts

Takeaway

The data clearly shows that fostering healthy lifestyle habits during early childhood is crucial for preventing overweight and obesity. The habits with the biggest impact are daily physical activity, a diet with very limited processed foods, snacks and sweetened beverages, minimal screen time, and emotional self-regulation.

However, these home-based interventions are easier to implement for parents with higher education levels, as research consistently shows a significant relationship between parental education and childhood obesity. Higher parental education levels are generally associated with lower rates of child overweight and obesity. This association follows an inverted U-shape across childhood, peaking around age 8 and narrowing in adolescence.

Given the critical importance of establishing a healthy foundation in that narrow timeframe, it is essential to implement measures that support and empower parents from lower socioeconomic or educational backgrounds. These efforts will be vital for addressing obesity prevention on a larger scale.

This is part one of a two-part series on the obesity epidemic where I will share the most up to date information on obesity and overweight broken down as follows:

• Part one: the context behind this unprecedented rise in obesity and the current gold-standard treatments

• Part two: obesity prevention with a focus on child obesity

Intro

Nearly half of the world’s population is currently overweight - 43% of adults and 16% of children. Of those, over 1 billion have obesity. Obesity among adults has more than doubled since 1990, and has quadrupled among children and adolescents (5 to 19 years of age). The World Obesity Federation's 2024 World Obesity Atlas projects that the number of adults living with obesity will continue to rise, reaching 1.53 billion by 2035.

There are two reasons why obesity represents one of the biggest health crises we’ve ever experienced: it directly contributes to nearly all leading causes of death and its economic impact is projected to reach $4.32 trillion annually by 2035, which is nearly 3% of the global gross domestic product (GDP).

The US has experienced one of the most significant surges in obesity, with rates tripling over the past 60 years. However, this issue has now become a global epidemic, with low- and middle-income countries witnessing some of the fastest-growing obesity rates. Even in Europe, obesity rates have nearly tripled since 1975.

Why are we fatter than ever?

At a basic level, weight gain — eventually leading to being overweight or to obesity — is determined by a balance of energy. The obesity crisis of the past decades is best explained as the result of a rapid mismatch between our evolved biology and drastically changed modern environments, particularly in terms of food availability and physical activity levels. This mismatch, combined with socioeconomic factors and insufficient policy responses, has led to a global epidemic that affects countries at all levels of economic development.

Evolutionary perspective

In ancestral environments, humans were hunter-gatherers who relied on a diet consisting of wild plants, fruits, nuts, and animal protein. Food availability was unpredictable, leading to periods of feast and famine. This variability in food supply meant that humans evolved to store excess energy as fat during times of abundance to survive during times of scarcity.

The ability to store fat was an adaptive trait that provided a survival advantage. The "thrifty gene hypothesis" suggests that genes promoting efficient fat storage were selected for because they helped our ancestors survive periods of food scarcity.

Hunter-gatherers expended significant energy in daily activities, including hunting, foraging, and traveling long distances. Interestingly, research suggests that our ancestors did not necessarily expend more energy on physical activity compared to modern humans. Hadza foragers, for example, had higher physical activity levels, but their total daily energy expenditure was similar to Westerners when controlling for body size. However, hunter-gatherer lifestyles involved more diverse and frequent physical movements coupled with a diet of completely unprocessed foods. The abrupt shift from an active outdoor lifestyle to a sedentary indoor one is a major factor in the prevalence of obesity and chronic diseases in modern society.

Modern environment and lifestyle

Simply put, today we are eating more and moving less.

Our current global food environment is characterized by an abundance of high-calorie, nutrient-poor foods, often rich in sugar, fat, and refined carbohydrates. These foods are easily accessible and heavily marketed. The consumption of processed foods has increased, leading to a higher caloric intake than our ancestors experienced. In the 1960s, the global average supply of calories was around 2,200 kcal per person per day. By 2022, this had increased to 2960 kcal.

Modern lifestyles involve significantly less physical activity compared to our ancestors. Many people have sedentary jobs, use cars for transportation, and engage in fewer physical activities. The overall energy expenditure has decreased, which, when coupled with higher caloric intake, contributes to weight gain.

The human brain is wired to find pleasure in consuming high-calorie foods, a mechanism that once encouraged energy intake in times of plenty. However, this reward system can become overstimulated by the availability of hyper-palatable foods, leading to overeating. Our bodies are still wired to store excess calories efficiently and are driven to seek out calorie-dense foods, a beneficial trait in a food-scarce environment but maladaptive in today's calorie-rich world.

Socioeconomic and cultural factors

Obesity rates are increasing in almost every country, regardless of economic status. Both high-income and low- and middle-income countries are experiencing rising obesity rates. North America, Latin America, and the Caribbean currently exhibit some of the highest obesity rates, however, regions like sub-Saharan Africa and parts of Asia are also seeing rapid increases in obesity rates due to economic growth and urbanization. In countries like India and China, the prevalence of obesity in cities is three to four times the rate in rural areas, reflecting higher incomes in urban areas and therefore higher levels of nutrition and food consumption, often coupled with less active labor.

It is a common misconception that overweight and obesity are primarily problems in the United States. In reality, the obesity epidemic is a global issue affecting countries around the world, including those traditionally considered 'thin,' such as many European nations. For instance, in Italy, while only 17.8% of the population is classified as obese, more than 50% are currently overweight. Across Europe as a whole, approximately 53% of the adult population is overweight or obese. No member state in the WHO European Region is on track to reach the Sustainable Development Goal target of halting the rise in obesity by 2025.

What about genes?

Genetics can influence an individual's susceptibility to weight gain and obesity. Some people may be genetically predisposed to gain weight more easily or have difficulty losing weight. Studies suggest that genetics account for 40-70% of the variation in body weight among individuals. This means that people can inherit a predisposition to obesity, which can influence factors like appetite regulation, metabolism, fat storage, and how the body burns calories.

However, research also shows that environmental factors may be more impactful than genetic factors. For instance, someone with a genetic predisposition to obesity may not become obese if they have a healthy diet and active lifestyle. Conversely, someone with a lower genetic risk may still develop obesity if exposed to an obesogenic environment.

Irrespective of an individual’s predisposition, at a macro level, genetic changes are unlikely to account for the rapid rise in global obesity. The gene pool, which represents the distribution of different genes within a population, tends to remain consistent over many generations. It takes a considerable amount of time for new genetic mutations or variations to become widespread.

If our genes have largely remained unchanged, then what has altered in the past 40 years to cause increased obesity rates? The answer lies in our environment—the physical, social, and economic factors that shape our eating habits and activity levels.

Why is it so hard to lose weight?

While weight loss is possible, maintaining weight loss is notoriously challenging, with studies indicating that 80-85% of individuals who lose a significant amount of weight regain it within a few years.

This difficulty is rooted in evolutionary biology, where our bodies are programmed to resist weight loss to survive periods of famine. As I mentioned in the beginning, the "thrifty gene hypothesis" suggests that genes promoting efficient fat storage were positively selected because they provided a survival advantage during frequent famines. These genes, however, have become maladaptive in modern environments where high-calorie foods are readily available.

The set point theory further complicates this by suggesting that each individual has a biologically predetermined weight range that their body strives to maintain, regulated by complex feedback mechanisms involving hormones like leptin (satiety) and ghrelin (hunger). When a person loses weight, their body responds by decreasing metabolic rate and increasing hunger signals to restore the lost weight, making sustained weight loss challenging. This theory explains why many people experience weight loss plateaus and often regain weight after dieting. The set point is thought to be an evolutionary adaptation to protect against starvation, ensuring that the body holds onto energy reserves during times of caloric deficit. However, this mechanism, which was beneficial in environments with food scarcity, is less useful in today's world of constant food availability. In short, our bodies fight more against weight loss than weight gain.

One perspective that I find particularly interesting is that of Stephan Guyenet in his book, The Hungry Brain. His model explains the inefficacy of traditional weight loss strategies by highlighting the fundamental mismatch between our brain's evolutionary wiring and the modern food environment. Guyenet argues that our brains are hardwired to seek out calorie-dense, highly palatable foods, which were scarce in our ancestral environment but are now ubiquitous. This leads to overeating and weight gain because our brain's reward systems are easily hijacked by these foods, making it difficult to resist them. Traditional weight loss strategies, which often rely on conscious decision-making and willpower, fail to address these deep-seated neural circuits that drive eating behavior. His insights suggest that more effective weight loss strategies need to consider the neurobiological factors that influence eating behavior and develop interventions that can modulate these brain circuits.

Current obesity treatments

A note on how we measure obesity

Obesity is primarily measured using Body Mass Index (BMI), which is calculated by dividing a person's weight in kilograms by their height in meters squared. The World Health Organization (WHO) defines overweight as a BMI of 25 or higher, and obesity as a BMI of 30 or higher. While BMI is widely used due to its simplicity and low cost, it has limitations as it doesn't account for differences in body composition, muscle mass, or fat distribution across diverse populations. To complement BMI, some global health surveys also use waist circumference measurements to assess abdominal obesity.

Current treatments

To date, the most common and historically successful approaches to obesity treatment have included:

1. Lifestyle modifications:

   • Dietary changes: reducing calorie intake, increasing consumption of whole foods while limiting processed foods.

   • Increased physical activity: regular exercise and increased daily movement.

   • Behavior changes: modifying eating habits, addressing emotional eating, and developing healthier coping mechanisms.

2. Medications:

   • FDA-approved weight-loss medications such as orlistat, phentermine-topiramate, and liraglutide, used in conjunction with lifestyle changes.

3. Surgical interventions (for severe obesity):

   • Bariatric surgery procedures like gastric bypass, sleeve gastrectomy, and adjustable gastric banding.

Bariatric surgery has been the most effective in terms of significant and sustained weight loss. Patients typically lose 30-50% of their excess weight within 6 months post-surgery and up to 77% within 12 months. On average, they maintain 50% of their excess weight loss 5 years after surgery. This efficacy is due to the physiological changes induced by surgery, which alter the digestive system and reduce calorie absorption. However, surgery is invasive, carries risks of complications, and requires lifelong dietary changes and medical follow-up.

In contrast, lifestyle modifications and medications are less invasive but often result in more modest weight loss and are harder to maintain long-term. Lifestyle changes alone can lead to a 5-10% weight loss, which is often regained without ongoing support. Medications can enhance weight loss by an additional 3-12% when combined with lifestyle changes, but weight is often regained once the medication is stopped.

The National Institutes of Health (NIH) states that it is nearly impossible for people with class III obesity (BMI ≥ 40) to sustain weight loss through diet and exercise alone.

GLP-1 drugs

GLP-1 receptor agonists (GLP-1 RAs), the latest and most promising class of weight loss drugs, are unique in their dual ability to effectively manage both type 2 diabetes and obesity. They work by controlling blood glucose levels, suppressing appetite, and reducing food intake. GLP-1s have shown remarkable efficacy, with newer formulations like semaglutide resulting in an average weight loss of 15-17%. This represents a significant breakthrough in obesity management, potentially approaching the weight loss achieved by bariatric surgery in a non-invasive form. The effectiveness of GLP-1 drugs is challenging obesity stigma and shifting perceptions towards viewing it as a treatable medical condition.

The market for GLP-1 drugs is expected to exceed $100 billion by 2030. Ongoing research is exploring combination therapies (such as tirzepatide, a dual GLP-1/GIP receptor agonist), oral formulations to improve convenience and adherence, and potential applications in treating other conditions like cardiovascular disease, heart failure, and liver disorders.

Like many other medications, the effects of GLP-1 receptor agonists on weight loss are typically not sustained once treatment is discontinued. This phenomenon is not unique to GLP-1 drugs but is common across various medications that address chronic conditions. When patients stop taking GLP-1s, they are likely to regain weight, similar to how discontinuing statins leads to a rebound in lipid levels. This occurs because GLP-1s work by suppressing appetite, slowing gastric emptying, and influencing metabolic processes while the medication is active in the body. Once the drug is no longer present, these effects cease, and the body tends to return to its previous state. Obesity treatment with GLP-1 medications is generally considered a long-term or indefinite therapy, rather than a short-term solution, to maintain the achieved weight loss.

For people already living with obesity, urgent care and access to treatment is the only real solution. Despite current limitations like high costs and supply constraints, the efficacy and multiple health benefits of GLP-1 drugs make them the most promising obesity treatment to date.

In the long run, however, prevention is the winning strategy because once you become overweight or obese, it becomes so much harder to lose weight.

TL;DR

• Nearly 43% of adults and 16% of children worldwide are overweight, with over 1 billion people classified as obese.

• Obesity among adults has more than doubled since 1990, and among children and adolescents, it has quadrupled.

• Obesity significantly contributes to nearly all leading causes of death and is projected to have an economic impact of $4.32 trillion annually by 2035, approximately 3% of global GDP.

• Economic growth, urbanization, and lifestyle changes have led to increased obesity rates across various regions, including sub-Saharan Africa and Asia.

• Human bodies evolved to store fat as a survival mechanism during times of food scarcity. This genetic predisposition is now maladaptive in an environment with abundant food and low physical activity.

• The "thrifty gene hypothesis" and the set-point theory explain why it is difficult to maintain weight loss. The body tends to resist weight loss by slowing metabolism and increasing hunger signals.

• GLP-1 receptor agonists are the most promising treatment for weight management, offering 15-17% average weight loss. However, weight tends to return after discontinuation, indicating the need for ongoing treatment.

• While treating existing obesity is essential, prevention remains crucial. Preventing obesity, particularly in children, could be a more effective long-term strategy as losing weight becomes increasingly difficult once overweight or obese.

In next week’s post, I will cover everything we know about obesity prevention and explain why I believe that one of the most powerful strategies we can employ is to focus on preventing child obesity.

It’s summer, so I’ll keep this post brief.

I’ve never been a sports enthusiast, but I love watching tennis. It’s the elegance of the sport, the athleticism, the tradition, the rigor. It reminds me of the years I spent training to become a professional ballerina, devoting every minute to making something insanely hard look beautiful. The magic of tennis extends beyond the play itself, with its marvelous level of precision, to everything that surrounds it and makes it possible—the pristine courts, the athletes’ style, the conduct of every single person on the court. Watching tennis just makes me want to do everything better.

But when I watched the Wimbledon finals this past weekend, I realized there’s another reason why I’m so drawn to tennis. The athlete’s modus operandi closely resembles that of an entrepreneur. Every top player’s career is built on thousands of hours of practice to perfect their technique and skill. There’s also raw talent and fierce determination that fuel the game, along with an entire team of best-in-class people whose job is to help the athlete win. But every time they step on the court and pick up the racket, the athlete is alone. Every step, every decision, every moment rests on their shoulders. And that’s where, in both tennis and entrepreneurship, the mental game comes in.

Earlier this year, I wrote a series of posts on mindset, drawing from mindfulness, neuroscience, and sports psychology. The latter is a field I’ve long been interested in because many of the tools experts use to help athletes perform at the highest level can be applied in other areas, including business. The most insightful book on the subject is The Confident Mind by Dr. Nat Zinsser, the Director of West Point's Performance Psychology Program. He has extensive experience training military cadets, world-class athletes, and other high-performing individuals. Unlike other books about high-performing people, this one wastes no time on anecdotes and instead provides the science behind confidence along with an incredible number of practical exercises for strengthening your mental game. Below are some of my favorite exercises from the book that have helped me feel more prepared to face work-related challenges.

To make better sense of the exercises, here’s a brief high-level summary of the book’s core ideas:

1. Confidence as a skill: the book emphasizes that confidence is not an innate trait but a skill that can be taught, improved, and applied by anyone to enhance various aspects of their lives and careers.

2. Mental bank account: Zinsser introduced the concept of a "mental bank account" where you can make deposits of Effort, Success, and Progress (ESP) memories. By regularly reflecting on and emphasizing these positive experiences, you can build and maintain confidence

3. Thought discipline: the book provides a framework for filtering out negative thoughts and emphasizing positive ones that align with your goals. It acknowledges that negative thoughts will occur but teaches you not to dwell on them.

4. Acceptance of nervousness: Zinsser dispels the myth that confidence eliminates nervousness. Instead, it teaches you to accept and reframe the biochemical shift experienced before important events as a natural and potentially beneficial response.

5. Visualization and mental rehearsal: Zinsser explains how imagining successful outcomes and mentally practicing scenarios can improve actual performance. He provides practical tips on how to incorporate these techniques into daily routines.

Exercise one: to strengthen your confidence, remember your successes, not your failures

• One-off: write a top-ten list of success moments that energized and encouraged you in the past.

• Daily “E-S-P” journaling practice: think about an episode during the day when you made your best “effort.” What kind of “success” did you experience at that moment and what kind of “progress” did you make?

Exercise two: think constructive, present tense thoughts about current and desired performance

• Create an affirming statement about something you do well now, phrasing it in the first person, in the present tense, and with positive, precise and powerful language.

• Write more affirmations in a notebook every evening to close your day with potent, positive thoughts.

Exercise three: imagine a positive future performance

• Envision perfecting a technical skill or specific task. Take an internal perspective, as if you were actually performing that task. Think specifically of the beginning, end and other critical points. Start by imagining you are sitting in a cozy chair in a special room surrounded by things that give you comfort and joy. Envision arriving at your place of performance. Vividly imagine the setting, and know what you want to have happen. Mentally walk through your warm-up, your first steps, the high points, your successful ending and the celebration that follows. Engage with the physical and emotional components of the visualization. Also visualize possible bumps in the road. Mentally rehearsing your response enables you to confidently deal with obstacles when they arise.

Exercise four: actively reinforce your confidence when circumstances threaten to undermine it

• When something doesn’t go as you hoped it would, consider that moment a chance for learning. To turn any failure into a lesson, treat it as a one-time situation and an aberration. Move on.

• When an internal voice threatens your confidence, call it out and tell it to shut up. Substitute that voice with affirming thoughts.

Exercise five: develop a “pregame routine” to prepare you for a challenge

• Conduct a “mental inventory” to assess what skills you bring to the task.

• Make an analysis of the performance ahead. What is the task at hand? What could be any opposing factors? Consider not only your “opponent”, but also think about any unexpected circumstances that might require your attention and solutions how to overcome them. Make yourself familiar with the setting.

• Shift from “preparing” mode to “delivering” mode. Establish a “statements only”rule: When moving into execution phase, stop questioning or doubting yourself regarding your physical or mental preparedness.

I love hearing from you and am grateful for your feedback, so please feel free to reach out with any questions or ideas about topics you’d like me to write about.

Exercise is the most potent intervention we currently have for longevity. If physicians prescribed exercise as freely as they prescribe medication, we’d likely see a tremendous drop in chronic disease rates and improved health outcomes for an extraordinary number of people. Meeting the minimum recommended 150 minutes per week of moderate-intensity aerobic activity provides significant longevity benefits, but higher durations and intensities are strongly associated with increased longevity and reduced mortality risk.

When it comes to exercise, the data is so unequivocal, that I will always encourage you to exercise as much as you can. However, since I received questions from people who are in phases of their lives where they cannot dedicate enough time to exercise (new parents, people extremely busy with work, etc.), I have decided to provide a framework for the most efficient types of workouts you can do with limited time and/or limited access to a gym. I will provide workout splits for different amount of time, along with specific exercises to focus on, minimal home equipment you can get, and some free resources for follow-along workouts. But whatever you do, please don’t take this information as permission to exercise less.

If you only have 150 minutes a week (2.5 hours)

If this sounds like a lot, it’s not. This is actually the minimum amount of time needed to start reaping the health benefits from exercise. If you do the math, 150 minutes per week comes down to about 20 minutes per day, which is probably less than most of us spend scrolling on social media or watching Netflix. The good news is that one of the workouts in this protocol will actually allow you to watch Netflix for an hour while doing it.

When you work out, there are always three things you aim to do: improve your cardiovascular fitness, build strength, and maintain mobility. Contrary to what some fitness influencers might encourage you to do, with only 150 minutes per week, the most efficient way to exercise is to split it into three sessions instead of doing a short workout every day. It’s much harder to maximize cardiovascular or strength outputs within a super short timeframe. If you can block two hour-long sessions and another half hour session here’s what you should focus on:

1. 1 hour of strength training

2. 1 hour of Zone 2 cardio

3. 20-30 minutes of VO2 max cardio

If you only have two hours per week, you could condense the Zone 2 cardio and VO2 max work in one session with 40-45 minutes of Zone 2 and 20 minutes of VO2 max. But I really encourage you to push for 2.5 hours in total if you can.

Strength training day

Since you only have one hour to work on building muscle strength, the most efficient way to do that is to focus on full-body compound movements that target multiple muscle groups at once. These include:

• Squats: target the quads, hamstrings, glutes, lower back, and core.

• Deadlifts: engage the hamstrings, glutes, lower back, traps, and core.

• Bench Press: works the chest, shoulders, triceps, and core.

• Overhead Press: targets the shoulders, triceps, upper chest, and core.

• Pull-Ups/Chin-Ups: engages the back, biceps, shoulders, and core.

• Rows: focuses on the back, biceps, and core.

• Lunges: target the quads, hamstrings, glutes, and core.

• Step-ups: work the quadriceps, hamstrings, glutes, and core.

• Push-Ups: works the chest, shoulders, triceps, and core.

• Dips: target the chest, shoulders, and triceps.

• Planks: engage the core, shoulders, and glutes.

• Kettlebell Swings: target the hamstrings, glutes, lower back, shoulders, and core.

• Dumbbell Snatch: targets the legs, hips, back, core, shoulders, and arms.

At the gym

If you can join a gym, I encourage you to do so. It doesn’t have to be fancy or expensive, just somewhere with all the equipment you need and as close to your home or office as possible. The reason I love working out in a gym is that walking into a space where you have room to move and all the equipment at your fingertips removes a lot of mental effort. Getting motivated by the other people working out is a bonus.

Here’s a full 1-hour workout example that targets all major muscle groups:

You will need to adjust the weights for each exercise based on your fitness level, but always remember that form and technique are more important than adding a ton of weight and potentially injuring yourself. If you have someone who can teach you proper form, that would be ideal. Otherwise, find YouTube videos that breakdown each move so you get a sense of how it’s performed.

At home

If working out in a gym is not an option, you can still get a great workout at home with minimal equipment. To do most of these compound movements, you only need dumbbells, kettlebells, a bench or sturdy chair and some resistance bands. For dumbbells, two sets would be ideal, with one set between 10-15 lbs and the other between 20-25 lbs. For the kettlebell you can go heavier, between 30-40 lbs.

Here’s the same 1-hour workout example adapted to your home “gym”:

Some of the free resources you can use for workout plans and follow-along workouts are the Nike Training app, YouTube and ChatGPT. With GPT, you can create programs for yourself based on these simple compound moves and the various weights you want to work with.

Zone 2 cardio day

Zone 2 cardio is typically defined as exercise performed at 60-70% of your maximum heart rate, where you can maintain a conversation but are breathing more heavily than at rest. Zone 2 cardio has a ton of benefits including: helps you build a strong aerobic foundation, enhances overall cardiovascular health, and improves endurance. It also burns fat, promotes metabolic health by improving insulin sensitivity, and aids in recovery between more intense workouts.

My preferred way to do Zone 2 is walking on a treadmill at an incline of 12 and a speed of 3mph. I usually listen to a podcast/ audiobook or watch a TV series while doing this. Based on your fitness level you can also do Zone 2 on a bike, rowing machine, swimming, hiking, jogging or stair climbing. Whatever you choose, don’t skip Zone 2 and measure your heart rate/ do a talk test to make sure you are exerting enough effort.

There are two ways to measure if you are in zone 2 while exercising:

1. Talk Test: A simple, non-technical method is the talk test. During zone 2 exercise, you should be able to maintain a conversation but not necessarily want to talk. If you can speak in full sentences without gasping for air, you are likely in zone 2.

2. Wearable Devices: The most accurate way to measure if you are in Zone 2 is by using a heart rate monitor. Zone 2 corresponds to 60-70% of your maximum heart rate. To calculate your maximum heart rate, you can use the formula: 220−your age. For example, if you are 30 years old, your estimated maximum heart rate is 190 beats per minute (bpm), and Zone 2 would be 114-133 bpm. A chest strap would be the best way to measure your heart rate in real time, but I find the Apple watch to be somewhat accurate too.

VO2 max cardio day

VO2 max represents the maximum amount of oxygen your body can utilize during intense exercise, and increasing it through targeted training enhances your heart's efficiency in pumping blood, improves lung capacity, and boosts the body's ability to deliver oxygen to working muscles. A higher VO2 max is associated with lower mortality rates and improved quality of life. Some if its numerous benefits include: reduced risk of heart disease, improved blood pressure regulation, better blood sugar control, enhanced fat burning, and increased overall energy levels.

The simplest way to incorporate VO2 max training is the Norwegian 4x4 protocol, a high-intensity interval training method that only takes 20-30 minutes. It consists of four 4-minute intervals performed at 85-95% of maximum heart rate, with each interval separated by 3 minutes of active recovery at a low intensity.

Here’s how to do it:

• Warm up for about 5 minutes (walk or light jog)

• Perform the first 4-minute interval at 85-95% max heart rate (as hard as you can sustain for 4 minutes without going all out)

• Recover actively for 3 minutes at low intensity (walk or very light jog)

• Repeat for a total of 4 intervals

• Cool down for 5-10 minutes

As with Zone 2, this can also be done with various cardio exercises like running, cycling, swimming, or rowing. I find it easiest on a treadmill, but you can also do it outside, on a track, or in a park.

If you (truly) only have 20-minute slots

For those situations where you really cannot set aside an hour-long session to workout, supersets and circuit workouts are the most efficacious solution. I love Kirsty Godso’s HIIT workouts on the Nike app, but here are a few examples you can do on your own:

Supersets

A superset is a circuit where you perform two exercises back-to-back with minimal to no rest in between. Ideally, you want to combine exercises that target different muscle groups.

Example:

Density circuits

A density circuit is a high-intensity workout method designed to maximize the amount of work you do in a set period. The goal is to complete as many rounds of a given set of exercises as possible within a specified time frame.

Example:

Tabata

A Tabata workout is a high-intensity interval training (HIIT) method that consists of 20 seconds of all-out intense exercise followed by 10 seconds of rest, repeated for a total of 8 rounds, making one Tabata cycle last 4 minutes.

Example:

Add more movement throughout the day

Irrespective of whether you have two or seven hours of dedicated exercise time, adding more spontaneous movement throughout the day will help you be healthier. This can be:

• Walking more. Walk your baby/ kid, do calls or meetings while walking, invite friends for a walk instead of a drink, take the stairs.

• Standing instead of sitting. Get a standing desk or set an alarm to stand for a few minutes every hour.

• “Exercise snacks”: Get up from your desk and do 10 push-ups, 20 squats, or one minute of mountain climbers multiple times throughout the day.

• Stretching and mobility: do 5-10 minutes of dynamic stretching when you wake up and before you go to bed and this will also help your nervous system reset.

Finally, if your circumstances change and you can add more workouts to your routine, start by adding one more strength training session. Over time, the goal is to progress to 2-3 strength training sessions and 2-3 cardio sessions per week.